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

4 Comments

  • DEE ANN THORNE YANCEY says:

    I’M A 71 YR OLD FEMALE. I HAD CHICKENPOX WHEN I WAS 6YRS OLD & I HAD THEM BAD. I TOOK THE SHINGLE SHOT AT AGE 50 YRS OLD. THEN ON MAY 17TH I HAD MY PACEMAKER/DEFIBRILLATOR CHANGED OUT. ON MAY 19TH I STARTED HAVING HORRIFIC PAIN IN MY BACK FROM ONE SIDE TO THE OTHER SIDE AND RADIATED INTO THE STURNUM CENTER. THE PAIN GOT WORSE DAY BY DAY & WITHIN A WEEK MAY @24TH THE PAIN WAS SO BAD I CRIED CONTINULY AND HOLLERED OUT IN MY SLEEP. I AM A DIABETIC W/NEUROPATHY AND HAVE
    FIBROMYALGIA. IT’S SO HARD TO KNOW WHAT IS GOING ON. I WENT TO MY PERSONAL PHYSCIAN FOR HIM TO LOOK AT MY BACK. HE RAN HIS TOOL THAT HAS A WHEEL W/SPOKES ON IT. WHEN HE RAN IT ON MY BACK SIDE TO SIDE & AND THE FRONT TO THE STURNUM I YELLED OUT IN EXTREME PAIN HE SAID ” LOOKS LIKE I HAVE INTERNAL SHINGLES” . I NEVER HEARD OF THAT BEFORE.
    WHEN I WENT TO PICK UP MY SHINGLES MEDICINE AND A NEW SIGN APPEARED ON THE COUNTER THAT SAID, “GET YOUR NEW SHINGLES SHOT HERE TODAY. 90% OF NOT GETTING SHINGLES”!! NOW THOSE OF US WHO HAVE SHINGLES OR HAD THE SHINGLES, SHOULD WE TAKE THE “NEW SHINGLES SHOT”???

    ALSO, I AM TAKING “VALACYCLOVIR 1GM TABS”. WHAT ELSE WOULD GET RID OF THE PAIN? TODAY IS THE 3RD WEEK SINCE I HAD SURGERY AND THE PAIN HAS NOT LET UP AT ALL. I WANT TO “SCREAM” CONTINUALLY!!! THIS IS “STRESSING ME MORE & MORE!!!
    PLZZZ HELP ME WITH ANY EXTRA INFORMATION I CAN GET FROM YOU. IT WILL B GREATLY APPRECIATED BY THIS 71 YR OLD LADY WHO FEELS LIKE A 171 YR OLD WITH EXTREME PAIN. BLESS YOU FOR POSTING INFORMATION FOR US. GOD BLESS YOU.

    • admin says:

      I am sorry you are going through this trouble. The pain of shingles is known as one of the worst of pains but thankfully is usually self-limited and will go away. The medications you are taking will help to shorten the duration of the symptoms. There is unfortunately little else you can do 🙁
      Best of luck!

  • Norine says:

    I had shingles diagnosed on 10/17/19. Rash, blisters, pain like you wouldn’t believe on left side of back wrapping to front. Supposed to have mid face lift and neck lift 12/26/19. Am I just asking for a relapse?

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