Shingles is a viral infection stemming from the varicella-zoster virus (VZV), the same pathogen responsible for chickenpox. After an initial chickenpox infection, VZV can remain inactive within the nervous system for many years. When this dormant virus reactivates, it can lead to shingles, a condition characterized by a painful rash. Shingles can affect any area of the body where nerve pathways exist, including the scalp and hairline.
Shingles on the Scalp
Shingles manifests on the scalp when the varicella-zoster virus reactivates and travels along nerve pathways, known as dermatomes, to the skin surface. The trigeminal nerve innervates the face and scalp, making these areas susceptible. The rash typically appears as a band or strip on one side of the head, respecting the midline, reflecting the path of the affected nerve. It can involve the scalp, forehead, and sometimes extend around the eye, a condition called ophthalmic shingles. Initial skin changes include discolored patches that quickly develop into bumps or blisters, often clustering into bands.
Identifying Scalp Shingles
Before the characteristic rash appears, individuals may experience prodromal symptoms like pain, burning, tingling, or itching on the scalp. These sensations can precede the rash by several days. Once the rash emerges, it typically presents as red patches that evolve into fluid-filled blisters. These blisters eventually crust over and form scabs.
The rash maintains a unilateral, or one-sided, distribution, following the specific nerve path. Blisters can form within the hair follicles, making them less visible. Accompanying symptoms may include headache, fever, fatigue, and sensitivity to light. If the rash affects the face, especially around the eye, it may be ophthalmic shingles, requiring immediate medical attention due to vision risk.
Seeking Medical Care and Treatment
Prompt medical attention is important for shingles, ideally within 72 hours of the rash’s onset, as early intervention can reduce its severity and duration. Antiviral medications, such as acyclovir, valacyclovir, and famciclovir, are commonly prescribed to shorten the illness and lower the risk of complications. Beyond antivirals, pain relief can be managed with over-the-counter medications like ibuprofen or acetaminophen. Applying cool compresses and keeping the affected area clean and dry can help prevent secondary bacterial infections. If left untreated or if treatment is delayed, complications such as postherpetic neuralgia (PHN) can occur, causing persistent nerve pain even after the rash has cleared.
Preventing Shingles
Vaccination stands as the most effective method for preventing shingles. The shingles vaccine, known as Shingrix, is highly effective in preventing the disease and its complications. The Centers for Disease Control and Prevention (CDC) recommends two doses of Shingrix for healthy adults aged 50 and older, and for individuals aged 19 and older who are immunocompromised. If shingles does occur in a vaccinated individual, the vaccine can lessen the severity of the illness and decrease the likelihood of developing complications such as postherpetic neuralgia. The vaccine works by boosting the body’s immune response to the varicella-zoster virus, thereby helping to prevent its reactivation.