Shingles on the Face: Pictures, Eye Warning Signs, Treatment and the Vaccine

Shingles on the face is a painful rash of blisters in a band on one side of the face, often across the forehead, around one eye or along the nose, that usually follows a few days of burning, tingling or pain in the same spot. It is caused by the chickenpox virus waking up in a nerve. Shingles on the face is a medical emergency because it can affect the eye, so see a doctor the same day: antiviral medicine works best when started within 72 hours.

Pori does not diagnose skin conditions; its selfie scans and photo diary in Pori can help you keep dated, consistent photos to show a dermatologist and see whether treatment is working.

What does shingles on the face look like?

The CDC says the shingles rash most commonly appears in a single stripe on the left or right side of the body, and that it can also appear on one side of the face. The one-sided pattern is the most useful clue: the rash follows one nerve, so it stays on one side of the face.

The rash usually unfolds like this:

1. Warning signs. Pain, itching or tingling where the rash will appear. The CDC says this can start several days before the rash, and some people get a fever first.
2. Red patches and blisters. Clusters of small fluid-filled blisters appear on a red or discolored base, in a band or patch on one side.
3. Scabs. The CDC says the blisters scab over in 7 to 10 days.
4. Healing. The rash usually clears within 2 to 4 weeks. The NHS says it can take up to 4 weeks to heal, and pain can last for weeks after.

Other symptoms can include fever, headache, chills and an upset stomach. MedlinePlus notes that the rash may involve the face, eyes, mouth, and ears.

What does shingles look like on brown and black skin?

The AAD says people with darker skin tones may see grayish, pink, dark brown, or purplish bumps, sometimes with a purplish color under the blisters or no color change at all. The NHS notes that the red color can be harder to see on brown and black skin. The one-sided band, the blisters and the pain before the rash are the signs to look for.

On the body, the same virus makes a band of blisters around one side of the chest, belly or back, which shows the pattern more clearly.

Why is shingles near the eye an emergency?

The AAD is blunt: having a shingles rash on your face is a medical emergency, and even if the rash is not on your eye, it could still affect your eyesight. The CDC lists vision loss as a complication when facial shingles affects the eye, and MedlinePlus warns that shingles affecting the eye may lead to permanent blindness without emergency care. When shingles involves the eye, doctors call it herpes zoster ophthalmicus.

Get care the same day, from an urgent care clinic, an emergency room or an eye doctor, if you have shingles signs and:

• The rash is on your forehead, eyelid or around the eye.
• The rash is on your nose. The NHS lists a rash on your eye or nose as a reason for urgent care. The American Academy of Ophthalmology's EyeWiki explains that blisters at the tip, side or root of the nose, called Hutchinson's sign, predict that the eye is likely to be involved.
• Your eye is red, painful, watering or sensitive to light, or your vision changes.
• You have weakness on one side of your face, ear pain, or blisters in or around your ear. MedlinePlus explains that shingles affecting the nerves of the face or ear can cause Ramsay Hunt syndrome, with trouble moving some face muscles.

What causes shingles, and is it contagious?

Shingles comes from the varicella-zoster virus, the same virus that causes chickenpox. After chickenpox, the virus stays in the nerves and can reactivate years later. The CDC estimates that about 1 in 3 people in the US will get shingles in their lifetime, about one million cases a year, and that the risk sharply increases after age 50. A weakened immune system also raises the risk.

You cannot catch shingles from someone with shingles. You can, however, pass on the virus. The CDC says it spreads through direct contact with fluid from the blisters, or by breathing in virus from blisters before they dry and scab. Someone who has never had chickenpox or the chickenpox vaccine can then get chickenpox. The NHS says you can only spread the infection while the rash oozes fluid.

• Keep the rash covered when you can, and do not touch or scratch it.
• Wash your hands often.
• Until the blisters have dried and scabbed, avoid pregnant people who have not had chickenpox, people with weakened immune systems, and babies, especially those under 1 month old.

What else could it be?

Our guide to the common causes of a rash on the face covers more look-alikes.

How is shingles on the face treated?

Antiviral medicine within 72 hours

The CDC says the antivirals acyclovir, valacyclovir and famciclovir work best when started within 72 hours of symptom onset. The NHS says you usually need to start them within 3 days of the rash first appearing, and the AAD recommends starting within 2 to 3 days. Do not wait for the rash to fill in: see a doctor as soon as you suspect shingles on your face. The AAD says to see a doctor even if more time has passed, and with facial shingles the eye still needs checking.

If the eye is involved, an eye doctor may add steroid eye drops for inflammation inside the eye and check you again over the following weeks. MedlinePlus notes that doctors may also prescribe pain medicines and antihistamines for itch.

Home care

• Apply cool, wet compresses to ease pain, as MedlinePlus suggests.
• Keep the rash clean and dry, and do not pick at blisters or scabs.
• Skip makeup and skincare on the rash until it heals, and use a clean towel each time.
• Ask a pharmacist about over-the-counter pain relief that suits you.

Complications to know about

The CDC says long-term nerve pain, called postherpetic neuralgia, is the most common complication, and it can last months or years after the rash clears. Other complications include vision loss, a bacterial infection of the rash and, very rarely, pneumonia, hearing problems or brain inflammation. Prompt treatment and vaccination both lower these risks.

Can the Shingrix vaccine prevent shingles?

Yes. The CDC recommends two doses of Shingrix for:

• Adults 50 and older, with the doses 2 to 6 months apart.
• Adults 19 and older with a weakened immune system, who can get the second dose 1 to 2 months after the first if needed.

The CDC says Shingrix was 97% effective in preventing shingles in healthy adults aged 50 to 69, 91% in adults 70 and older, and 91% effective against postherpetic neuralgia in adults 50 and older. In adults with weakened immune systems it was 68% to 91% effective.

• If you have had shingles, the CDC still recommends Shingrix to help prevent it coming back; wait until the rash has cleared.
• If you had the older Zostavax vaccine, you should still get Shingrix.
• You can get it whether or not you remember having chickenpox.
• Common side effects include a sore arm, redness and swelling at the injection site, tiredness, muscle pain, headache, fever or nausea, which the CDC says usually go away in 2 to 3 days.

When should you see a doctor?

With shingles on the face, the answer is now. Contact a doctor the same day if you have a painful, one-sided rash with blisters on your face, scalp, forehead or nose, or burning pain on one side of your face that is followed by a rash. The NHS also advises urgent care if you are pregnant, have a severely weakened immune system, or are 17 or younger. After the rash has healed, a dermatologist near you can help with any scars or dark marks left behind.