Shingles and Cosmetic Surgery

Shingles and Cosmetic Surgery

Shingles outbreaks in cosmetic patients

 

Shingles or zona is a viral infection caused by the herpes zoster virus in which the patient develops a particularly painful rash and small blisters in the affected part of the skin that may take weeks to heal. The infection is more common in women and patients over 50.

Causes of shingles

The virus that causes herpes zoster is a reactivation of the virus that causes chicken pox in children, the varicella zoster virus. After a chicken pox infection, the virus hides in the base of the nerve of a particular skin area, commonly the trigeminal nerve, which provides sensation to the face and neck. When reactivated, the virus travels down the nerve and bursts out of the skin through small blisters.

Confusion with cold sores

Another totally different virus, confusingly called the herpes simplex virus, is the cause of two other types of infections that are similar but not the same.

Herpes simplex type 1 virus is the one that causes the common “fever blisters” or “cold sores” that appear on the lips. Herpes simplex type 2 virus is responsible for genital herpes infections where small blisters occur sporadically around the genital organs.

Both the herpes simplex viruses and their infections are spread by close contact to the shedding viruses from the blisters. In contrast, herpes zoster, or shingles, can only occur in patients who have been previously exposed to the varicella virus.

Herpes infection of the eye

Shingles in plastic surgery

Any surgical intervention, trauma or even stress, both physical and psychological, can cause the herpes zoster virus to cause an infection. We really do not understand why it occurs, but being immune-compromised seems to help it along. Any cosmetic plastic surgery procedure, and especially those around the head and neck, such as eyelid operations (blepharoplasty) and facelifts (rhytidectomy), come with this risk.

The patient will initially complain of pain in the affected area, which is normal after any surgery . The pain will intensify and get worse rather than better, and a rash may develop in a particular nerve distribution of the skin. Then the phase of blistering occurs. Finally, after a few weeks or months (!), the blisters dry out and the infection recedes.

Treatment of shingles

Once the infection occurs, treatment is aimed at pain relief and shortening the duration of the symptoms. Drugs that may be prescribed include;

  • Analgesics – to decrease pain
  • Antiviral drugs – to decrease the duration of infection
  • Steroids – to decrease inflammation (+/- efficacy)

Shingles vaccine

A vaccine, Zostavax, is available for patients who are at risk of developing shingles—those over age 60 and those who are immune-compromised.

Interestingly, having three servings of fresh fruit a day will decrease your chance of getting a shingles attack by 30%!

Complications of shingles

As if it were not bad enough, after the initial viral infection is over, the patient may continue to have sequale of the infection including:

  • Bacterial infections – the bacteria see the weakened body and attack, causing another infection
  • Neuralgia – pain in the area of the nerve that persists for months, even after the rash is gone
  • Blindness – this can occur if the viral infection has attacked the nerve going to the eye area
  • Muscle weakness

What to do to prevent shingles?

  • Eat fruit
  • Consider taking the vaccine
  • Pre-treat prophylactically with antivirals if you are susceptible to these infections
  • Get treatment at the first sign of infection
  • Have a high level of suspicion if pains are getting worse rather than better