What to know about shingles in the mouth

Oral shingles is an infection that can develop from the varicella-zoster virus (VZV) reactivating in the body. This virus can also cause chicken pox.

If you have had prior exposure to VZV, you might be at risk for shingles. After you heal from VZV, it can stay dormant in the body and reactivate years later as shingles. This can cause a painful rash on the body. 

Shingles in the mouth can lead to mouth ulcers and symptoms on the face and outer skin. Treatment with antiviral medications can shorten the amount of time you have to manage these symptoms and can prevent long-term complications.

What are the phases of shingles in the mouth?

Oral shingles can cause a rash and painful blisters to develop inside the mouth. Shingles symptoms may start before you notice the rash and can continue after the rash goes away.

There are 3 phases of an oral shingles infection:

Phase 1

Phase 1 includes feeling tingling, pain, and burning inside your mouth where a rash typically appears. Some people describe this as feeling similar to a toothache.

You might also experience other symptoms such as:

• malaise, a general feeling of being unwell
• headaches
• light sensitivity
• fever

Phase 2

The second phase can often involve a severely painful, blistering rash inside the mouth, typically on the roof of your mouth, gums, or tongue. The rash may begin with changes in skin color and turn into raised, fluid-filled blisters.

Some people with shingles in the mouth also experience a rash and blistering on one side of the face. The blisters eventually open and crust over during the process of healing.

It usually takes about 2–4 weeks for a shingles rash to clear up, but mouth sores can clear up within 10–14 days.

Phase 3

After the rash clears, some people experience a chronic infection. They might have debilitating pain that comes back again and again and might last 12 months or longer.

As well as pain, they might feel shock sensations, burning, or prickling. This ongoing pain called post-herpetic neuralgia (PHN) is a complication of shingles.

You might also experience other symptoms if you have shingles in the mouth. One case report describes an ulcer (open sore) inside the mouth, along with peeling skin and ulceration of the face.

What are the causes of oral shingles?

The VZV is the cause of an oral shingles infection. VZV can also cause chickenpox. After a chickenpox infection, VZV stays dormant in the body. If it reactivates, it can cause shingles to develop.

Shingles can occur when the immune system is unable to manage VZV. Older adults are at an increased risk of developing shingles, as are people with compromised immune systems.

About 30% of people hospitalized for shingles are also immunocompromised.

There are several triggers that might cause VZV to reactivate, such as:

• emotional stress
• immunosuppressant medications
• acute or chronic illness
• exposure to the VZV virus
• cancerous tumors

Treatment options for oral shingles

The primary treatment for oral shingles is antiviral medication. If you start the antiviral course within 3 days of the rash appearing in your mouth, it can prevent complications such as PHN. Antivirals can help clear up the rash more quickly and reduce its severity.

Antiviral medicines for oral shingles include:

• Acyclovir (Zovirax): Acyclovir is available as a tablet, capsule, or oral suspension. The typical dosage is 800 milligrams (mg) to be taken 5 times a day for 5 days.
• Valacyclovir (Valtrex): Valacyclovir is available as a tablet. The usual dosage is 1 gram (gm) to be taken every 8 hours for 7 days.
• Famciclovir (Famvir): Famciclovir is available as a tablet. The typical dosing schedule is 500 mg every 8 hours for 7 days.

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A doctor might also recommend medication to reduce pain, such as acetaminophen (Tylenol) and ibuprofen (Advil).

You can also take steps to help manage the symptoms of mouth ulcers that might come with oral shingles. This includes:

• avoiding spicy, acidic, or salty foods to prevent irritation
• avoiding hot foods
• choosing warm or cold soft foods such as soups
• brushing with a soft toothbrush and avoiding hard bristles

You might also want to check the ingredients of oral hygiene products, such as mouthwashes and toothpaste. Some components, such as alcohol, might also cause irritation.

A natural toothpaste or one recommended by a dentist might cause less pain and still allow you to keep up with your oral care routine.

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When should you speak with a doctor?

Early treatment for oral shingles can prevent complications such as PHN, which is burning pain along the skin’s nerves. Starting a course of antiviral medications can also decrease the amount of time you have to manage symptoms such as painful blisters and sores.

Consider talking with a healthcare professional as soon as you notice a rash or sores. They can diagnose a case of shingles and prescribe a course of antiviral medication if it’s suitable.

A healthcare professional can diagnose oral shingles by:

• conducting a physical examination of your mouth
• taking a history of your recent symptoms
• taking a sample of the fluid inside of a blister

A healthcare professional may also be able to conclude you have shingles in the mouth based on a physical examination alone. A lab test to look for the VZV in the fluid of a blister can confirm this diagnosis.

Summary

Shingles in the mouth can occur VZV reactivates in the area of skin connected to the trigeminal nerve.

You can experience symptoms inside your cheek, on your gums and palate, and on facial skin. If you suspect you may have oral shingles, it can be important to speak with a healthcare professional as soon as possible to help avoid complications, such as PHN.

A healthcare professional can help put together a suitable treatment plan, such as antiviral medications.

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