Prognosis and complications of shingles

The rash and pain usually subside within 3 to 5 weeks. There are numerous complications possible, many depending on which dermatome was affected.


Postherpetic neuralgia
Postherpetic neuralgia is pain in a previous shingles zone; this occurs in some 10% of patients (often elderly). Burning, continuous pain responds poorly to analgesics. Depression is almost universal. Treatment is unsatisfactory but there is a trend towards gradual recovery over 2 years. Amitryptyline is commonly used. Methyl-prednisolone intrathecally is sometimes helpful.


Ophtalmic complications
In cranial nerves, herpes zoster has a predilection for the fifth and seventh nerves. ‘Ophtalmic’ herpes is infection of the first division of the fifth cranial nerve. This can lead to corneal scarring and secondary panophthalmitis.


Ramsay Hunt syndrome
Geniculate herpes (geniculate ganglion of seventh cranial nerve) is also called Ramsay Hunt syndrome. There is a facial palsy with herpetic vesicles in the external auditory meatus (this receives a sensory twig from the facial nerve) and / or on the soft palate. Deafness, or a fifth nerve lesion may occur.


Local complications
Local complications are secondary bacterial infection, very rarely local purpura with necrosis (purpura fulminans), generalized zoster, and postherpetic neuralgia.