Shingles complications: what can go wrong and how to avoid them

Shingles (herpes zoster) can be more than a painful rash. For some people it causes lasting problems — most commonly postherpetic neuralgia, ongoing nerve pain that can last months or years after the rash heals. Older adults and people with weaker immune systems face the highest risk.

Postherpetic neuralgia (PHN) feels like burning, stabbing, or constant aching where the rash was. It can disrupt sleep, mood, and daily function. If pain from shingles lasts more than 90 days, ask your doctor about treatments such as gabapentin, pregabalin, certain antidepressants, or topical lidocaine. Early antiviral treatment during the first 72 hours of rash can lower the chance of PHN.

Other serious complications

Shingles can affect more than skin nerves. If the rash is on the face, especially near an eye, the virus can damage the eye and threaten vision — urgent care from an eye specialist is critical. A rash near the ear with facial weakness may be Ramsay Hunt syndrome, which can cause long-lasting facial paralysis and hearing problems.

Bacterial skin infections sometimes develop when blisters get infected. Keep the area clean, avoid scratching, and see a doctor if redness, spreading warmth, pus, or fever appear. In people with weak immune systems, shingles can become widespread and affect internal organs.

Some large studies show a short-term rise in stroke and heart attack risk after shingles, especially when the virus involves the brain or nerves close to blood vessels. The extra risk seems highest in the weeks to months after an outbreak, so managing pain and seeking medical follow-up makes sense, especially if you have other cardiovascular risk factors.

Practical steps to reduce risk

Vaccination is the most effective prevention. The recombinant shingles vaccine (Shingrix) cuts the chance of shingles and PHN dramatically and is recommended for older adults. Talk to your provider about timing and if it’s right for you. If you get shingles, start antiviral medicines like acyclovir, valacyclovir, or famciclovir as soon as possible — ideally within 72 hours of the rash appearing.

Control pain early with over-the-counter options (acetaminophen, ibuprofen) and ask about prescription options if pain is severe. Use cool compresses, loose clothing, and gentle skin care to ease irritation. Watch for signs of eye involvement, bacterial infection, high fever, or trouble breathing — those need immediate medical attention.

Finally, if you’re over 50, have chronic illness, or take immune-suppressing drugs, talk to your doctor about getting the vaccine and what to do if shingles appears. Quick action cuts the odds of long-term complications and helps you get back to normal sooner.

Quick checklist: call your doctor if the rash involves an eye, you get severe or spreading redness, fever above 101°F, new weakness or numbness, sudden hearing loss, or if pain is not controlled by prescribed meds. Keep a photo of the rash and note when it started. That helps your provider decide faster and can make treatment simpler and more effective. Also ask about pain referral options.