Understanding Shingles on the Scalp
Shingles, a viral infection, results from the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After a chickenpox infection, the virus can lie dormant in nerve tissues for decades. Shingles can manifest on the scalp and within the hair, presenting as a painful rash.
This rash typically begins as red patches that develop into fluid-filled blisters, which then dry out and form crusts over several days. The rash on the scalp often follows a specific nerve path, appearing on one side of the head and not crossing the midline. It can extend from the scalp to the forehead, face, or neck. The rash on the scalp looks similar to shingles on other body parts. While the scalp is a less common location for shingles compared to the torso, the infection itself is identical.
Underlying Causes and Common Symptoms
The varicella-zoster virus (VZV) remains inactive in nerve cells near the spinal cord and brain after a chickenpox infection. Various factors can trigger this dormant virus to become active again, including aging, stress, illness, or a weakened immune system. When reactivated, the virus travels along nerve fibers to the skin, causing the characteristic rash and pain.
A hallmark symptom of shingles is nerve pain, which often precedes the appearance of the rash by several days. Individuals may experience a range of sensations, including burning, tingling, itching, stabbing, or throbbing pain in the affected area. This pain can be mild to severe and is often described as highly sensitive to touch. Other systemic symptoms like headache, fever, and general fatigue or malaise can accompany the outbreak.
Shingles on the head or face carries specific risks for complications due to proximity to sensory organs. Postherpetic neuralgia (PHN), a persistent nerve pain, can last for months or even years after the rash clears. If the rash occurs near the eye, herpes zoster ophthalmicus can develop, potentially leading to vision problems or blindness without prompt treatment. Involvement of nerves near the ear can result in Ramsay Hunt syndrome, which may cause hearing loss or facial paralysis.
Managing and Preventing Shingles
Early treatment of shingles is important to reduce the severity and duration of the illness, and to lower the risk of complications. Antiviral medications, such as acyclovir, valacyclovir, or famciclovir, are typically prescribed within 72 hours of the rash’s onset. These medications can help shorten the course of the infection and alleviate symptoms.
Managing symptoms involves addressing the pain and discomfort associated with the rash. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help with mild to moderate pain. Cool compresses applied to the affected area and calamine lotion can provide relief from itching and irritation. For severe pain, prescription pain medications may be necessary.
It is advisable to seek medical attention promptly if the rash appears near the eye, or if severe pain, signs of bacterial infection (like pus or increasing redness), or a compromised immune system are present. Prevention of shingles is possible through vaccination. The shingles vaccine, Shingrix, is recommended for healthy adults aged 50 and older, and for adults 18 and older who are immunocompromised, to significantly reduce the risk of developing shingles and its associated complications.