Shingles complications include postherpetic neuralgia, vision problems, and secondary bacterial infections. Prompt shingles treatment can help prevent complications.

Shingles happens due to the reactivation of the varicella-zoster virus, which is the virus that causes chickenpox. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 3 people will develop shingles during their lifetime.

The main symptom of shingles is a rash that’s often painful, tingly, or itchy. While shingles can eventually go away with treatment, it can also lead to various complications. Continue reading to learn more.

Postherpetic neuralgia (PHN) is nerve pain that continues for more than 3 months after the shingles rash has cleared. While PHN goes away for many people, for others it can last for years or be permanent.

The main symptom of PHN is nerve pain at the site where your shingles rash was. This pain can be constant or may come and go. People often describe it as stinging, burning, or shooting. Other sensations may also be present, such as:

Medications can help with nerve pain. These include oral medications, like amitriptyline or gabapentin, and topical treatments, like lidocaine or capsaicin.

If these medications don’t bring relief, a healthcare professional may recommend a nerve block to reduce pain.

Shingles can cause a variety of vision problems when it affects the eye. When this happens, it’s called herpes zoster ophthalmicus (HZO). Experts estimate HZO affects 10–20% of people with shingles.

The symptoms of HZO typically start 2–4 weeks after the shingles rash first appears. It can cause a variety of eye problems, such as:

  • conjunctivitis, commonly known as pink eye
  • episcleritis, which is inflammation of the tissue between your eyelid and the white of your eye
  • keratitis, which is inflammation of the clear outer layer of the eye called the cornea
  • uveitis, which is inflammation of the middle layer of the eye called the uvea
  • optic neuritis, which is inflammation of the optic nerve that sends signals from your eyes to your brain
  • glaucoma, which can cause vision loss due to high pressure in the eye
  • damage to the retina, which is the part of your eye that converts light into electrical signals

HZO is an emergency because its effects can potentially lead to vision loss.

Treatment involves antiviral medications you can take orally or as eye drops. Corticosteroids can also help reduce inflammation.

Bacterial infections can also develop from scratching or picking at a shingles rash. This is because it’s possible for bacteria to enter your body through a break in the skin.

Many secondary bacterial infections that happen with shingles are due to the bacteria Staphylococcus aureus. Symptoms of a skin infection can include the following in the affected area:

  • redness or discoloration
  • swelling
  • skin that’s tender, painful, or warm to the touch
  • drainage of pus

Healthcare professionals typically treat bacterial infections with antibiotics. If an abscess has formed at the site of the infection, a doctor may use a needle to drain it as a part of your treatment.

In addition to PHN, shingles can also cause a variety of other neurological, or nervous system, problems. These are typically rarer and may include:

  • nerve palsies, which happen due to nerve damage and cause muscle paralysis
  • encephalitis, which is inflammation of the brain
  • meningitis, which is inflammation of the tissues lining the brain and spinal cord
  • myelitis, which is inflammation of the spinal cord that can lead to muscle weakness or paralysis
  • Ramsay Hunt syndrome, which can lead to facial paralysis, tinnitus, vertigo, and hearing loss
  • zoster sine herpete, which is shingles nerve pain without a rash

Treatment for neurological problems from shingles depends on the specific issue. However, treatment may involve antiviral medications and potentially corticosteroids to lower any inflammation.

Some additional, rarer complications of shingles include:

  • pneumonia, which is an infection of the lungs
  • vasculitis, which is swelling of the blood vessels that can affect blood flow and increase the risk for a variety of health problems, like stroke
  • tooth problems, which can lead to tooth loss
  • disseminated zoster, which is a widespread type of shingles

Shingles complications in older adults

The rate of shingles increases with age, and the risk of complications increases sharply after age 50. Shingles complications like PHN, HZO, and others become more common the older you are when you develop shingles.

Older adults and people with weakened immune systems are also more likely to be hospitalized with health problems linked to shingles. Additionally, most shingles-related deaths occur in these groups.

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The most optimal way to prevent shingles complications is to prevent shingles from developing in the first place. Getting the shingles vaccine, called Shingrix, can help prevent shingles.

The CDC recommends two doses of Shingrix for all adults ages 50 years and over and all adults ages 19 years and older with a weakened immune system.

People who should not get Shingrix include:

  • anyone who has had a previous severe allergic reaction to Shingrix or any of its ingredients
  • people who currently have shingles
  • pregnant people

If you do develop shingles, it’s important to talk with a doctor as soon as you can, ideally within 3 days of getting the rash. Receiving prompt treatment for shingles can help lower your risk of complications.

What is the most common complication of shingles?

PHN is the most common complication of shingles. The CDC notes that 10–18% of people with shingles will experience PHN.

How long does it take to recover from shingles?

According to the American Academy of Dermatology, shingles blisters clear in 7–10 days, while the rash typically goes away in 2–4 weeks.

Nerve pain may linger longer than skin symptoms, typically fading after 1–2 months. Nerve pain that lasts longer than 3 months is classified as PHN.

Are there long-term effects of shingles?

The complications of shingles can have several long-term effects. Examples include chronic nerve pain due to PHN, vision loss, and hearing loss. That’s why it’s vital to seek treatment if you suspect you have shingles.

Shingles can cause several complications. The most common is PHN, when shingles-related nerve pain lasts longer than 3 months. Other complications include vision problems, bacterial infections, and other neurological problems.

The risk for shingles and its complications increases with age. You can help prevent shingles by receiving the Shingrix vaccine when you’re eligible.

If you do develop shingles, try to talk with a doctor as soon as you can. Starting treatment early can help reduce the risk of experiencing shingles complications.