That could be because antivirals work best when taken within 72 hours of symptom onset, according to Dr. Washer. As a result some providers may be reluctant to prescribe antivirals if it’s been more than three days since you first noticed symptoms, she explains. Still, immunocompromised patients, those developing active lesions in new areas, or anyone with shingles on their face may be treated with antivirals regardless of the timing, Dr. Washer adds.
That last scenario—having a shingles rash on your face—doesn’t just get doctors’ attention because it can be unsightly. “If somebody has a facial rash either across their forehead or, particularly, if they have lesions on their nose, those patients really should see their physicians, they should get started on antivirals, and they probably should see an ophthalmologist,” Dr. Washer says.
The seriousness lies in which nerve may be affected, Dr. Foad says. The shingles virus lurks silently within sensory nerve cells and, once reactivated, pops up along dermatomes. Each of these patches of skin corresponds to a specific nerve that feeds sensory information—e.g., pain, temperature, and itchiness—to and from the spinal cord.
For example, the same nerve that serves the tip of the nose also serves the eye. So if you have a shingles infection on your nose, it could actually travel along the nerve and impact your vision. “You don’t want to get shingles in your eye because then that could lead to blindness,” Dr. Foad says. “Cosmetically, you don’t necessarily want to have shingles on your face, but the bigger thing is that you definitely don’t want it to be in the nerve that goes to the eye.”
When Jamie Smith*, then 28, felt a slight tingle at the tip of her nose, she thought it was just the start of a “weird pimple,” but after a rash developed on the left side of her nose, an urgent care provider diagnosed her with shingles. It wasn’t long before the rash spread to her eye, and before she knew it she had seen a slew of physicians: a primary care doctor, a dermatologist, an ophthalmologist, and even an otolaryngologist (an ear, nose, and throat specialist).
At the time Smith was a new mom attempting to juggle her return to work in an emotionally demanding career, a round-the-clock schedule of breastfeeding and pumping, marital strain, and her grandmother’s cancer diagnosis. “The whole experience was extremely traumatic and life-changing,” she shares. “Shingles was my wake-up call that all the emotions and stress I was dealing with would catch up to me and manifest physically.”
Like other viruses varicella-zoster is an “invader” that preys on a weakened defense, i.e., a compromised immune system. While another physical illness or injury can impact how susceptible you are to shingles, mental stress often also seems to be associated with the virus getting reactivated, particularly among younger patients, both experts say.
“We live in a world that has so much stress, and I think that younger people are under more stress,” Dr. Foad says of the high-demand lifestyle many young adults are trying to maintain. “Shingles is a disease that can be activated when somebody’s immune system is a little bit down, and we know that stress is a big factor in that. [So] it doesn’t surprise me that you can find younger people who are starting to get reactivation of the disease.”
