A positive Hutchinson’s sign on the face is an early indication of a shingles infection. It refers to a painful rash that usually starts near or at the tip of your nose and that may involve your eye. Prompt medical attention is advised.
Shingles is caused by the varicella-zoster virus, the same virus responsible for chickenpox. Shingles rashes may develop almost everywhere on the body, including the face and eyes.
Hutchinson’s sign refers to a vesicular rash (made of tiny blisters) that starts near or at the tip of your nose. It is a sign of shingles and may indicate the virus may get to your eye.
Medical professionals may refer to positive and negative Hutchinson’s signs. In sum, a positive Hutchinson’s sign means the tip of your nose is affected, while a negative sign may indicate other parts of the face and nose are affected, but not the tip. Generally, a positive Hutchinson’s sign suggests shingles may compromise the eye.
A positive Hutchinson’s sign on your face indicates reactivation of the varicella-zoster virus on the trigeminal nerve, specifically in the ophthalmic (eye) branch. In other words, it is a sign of shingles on the face with a high chance your eye may be affected.
The trigeminal nerve has three branches that extend to different parts of your face. The ophthalmic branch gives sensory innervation to the skin, membranes, and sinuses in your upper face and scalp, including:
- forehead
- upper parts of the sinuses
- upper eyelids
- eye structures
- bridge and tip of the nose
Because this nerve extends to the tip of your nose, shingles can sometimes start to manifest there.
Irritation and a rash along one side of your nose, forehead, and sometimes scalp may be early shingles signs. The eye and upper eyelid on the same side may also be affected.
If you have a positive Hutchinson’s sign, you
- vesicles (small blisters) along and on the tip of your nose
- pustules (small bumps similar to pimples) along and on the tip of your nose
- burning or shooting sensations in the affected area
- occasional “pins and needles” sensation (paresthesia) in the affected area
These are all early signs of shingles.
Before a rash manifests, you may feel irritation, itchiness, or pain in the area, including the tip of your nose. After a few days, you may notice your skin getting red and raised, and clusters of tiny fluid-filled blisters starting to form.
The rash may become increasingly painful. It may also ooze and bleed, and your skin may change texture and color.
General signs of shingles may also include:
- fever
- fatigue
- headache
- flu-like symptoms
A shingles rash that starts at the tip of your nose may spread quickly along one of the sides of the nose and your forehead. The eye and upper eyelid on that side may also be affected.
If shingles has already spread into an eye, you may have the following additional symptoms:
- burning or throbbing pain in the affected eye
- redness around and on the eye
- watery eye
- persistent eye irritation
- blurry vision
- extreme sensitivity to light
Hutchinson’s sign may look differently depending on your skin tone, stage of the disease, and other factors. One common thing to look for is a painful vesicle (blister) or “pimple” at the tip of your nose.
If you find a suspicious-looking blister at the tip of your nose, you may also experience other symptoms of shingles, especially pain or itchiness in the area, flu-like symptoms, headache, or fever.
If it looks like it may be shingles or if you’re unsure, it may be a good idea to contact a healthcare professional immediately.
If not treated on time or left untreated, eye shingles may lead to
- severe conjunctivitis (pink eye)
- uveitis (inflammation of the middle layer of your eye)
- keratitis (inflammation of the top layer of your eye known as the cornea)
- glaucoma (a condition that damages your optic nerve)
- blindness in the affected eye
Studies show that the presence of a positive Hutchinson’s sign, compared to ophthalmic shingles without Hutchinson’s sign, quadruples your chances of developing severe eye complications.
Whether you have ophthalmic shingles with or without Hutchinson’s sign, treatment of the underlying viral infection is the same.
After confirming that you have ophthalmic shingles, a healthcare professional will likely prescribe antiviral therapy.
The prescribed antiviral medications usually come in tablet or liquid form and can be taken at home.
Ideally, you start antiviral treatment within 72 hours of noticing the first signs on your nose or face. Antiviral medications shorten the length and severity of shingles symptoms and reduce the chance of complications.
The treatment course typically lasts
Your health team may also refer you to an ophthalmologist (an eye doctor) for a consultation. They will examine the affected eye to see if there is any damage from the virus. If needed, they will prescribe additional treatment to minimize the risk of complications, like glaucoma.
Active shingles rashes are highly contagious. If someone comes in contact with your rash and has never had chickenpox before, they may develop that condition. If they already had chickenpox, they may develop shingles instead.
If you’re a new parent, you may also take some steps to protect your baby when nursing or handling them.
The term “Hutchinson’s” can have other meanings unrelated to shingles:
- Hutchinson’s pupil: This term indicates that your pupil doesn’t contract in response to light. This may happen after a concussion or another brain injury.
- Hutchinson’s melanotic freckle (lentigo maligna melanoma): This is a rare type of melanoma (skin cancer) that usually affects older people.
- Hutchinson’s sign in other parts of the body: Black pigmentation (usually a line) on your nail extending to the skin edge, which can also indicate a type of melanoma.
- Hutchinson’s triad: A combination of three symptoms common in congenital syphilis (a form of syphilis that babies acquire from their birth parent).
These terms have similar names because they are all named after Sir Jonathan Hutchinson, a British doctor who studied eye and skin diseases.
Hutchinson’s sign is an early indicator of ophthalmic (eye) shingles. It refers to painful vesicles or bumps at or near the tip of your nose. You may have other symptoms of shingles that accompany Hutchinson’s sign, including fever, headache, and pins and needles sensations.
If you think you may have a positive Hutchinson’s sign on your face, seeking immediate medical help is highly advised. If left untreated, shingles on the face may spread into your eye and lead to complications like vision loss.
Antiviral therapy is an effective treatment for shingles in the face, especially if you start it as soon as possible after the beginning of your symptoms.