What Do You Know About Shingles Being Triggered in the Trigeminal Nerve As a Result of Injectables and Frequency and Warnings?

Question

I posted a couple days ago about horrific pain on my scalp and face mottling within hour of 6 large box restylane. RN no help. ER doc DX shingles, only on face where mottling was and scalp. 58, had chickenpox, cold sores frequently, would never get injectable there. I think I should have been told about this possibility. product label mentions it may be a "herpetic trigger" I understand some docs take this history and advise on possibility of trigger, especially someone over 50.

	update:
	Finally diagnosed properly. Not shingles. Doc says I have to wait it out. I'm upset, still in pain, sores and dark places on side of face, hairline to almost chin, sores, tingling, pain, sores on large area scalp, swelling both sides of head still, Want this to be over soon. Any ideas? Should I see a neurologist or other specialist? Aching pain constant, need advil all the time. Worried about permanent scarring and who knows what else. Any thoughts, please.

Kenneth D. Steinsapir, MD · Answer

Shingles triggered after an injectable session is rare. Far more common is a cold sore caused by herpes simplex. You did have a very large treatment so it is consistent with triggering shingles. However this is not really something we expect even if you have a history of past shingles episodes. I would recommend seeing your internist regarding the shingles. Certainly individuals with a known history of herpes are candidates for prophylactic antiviral treatment. Shingle is terribly uncomfortable and it would be understandable if this experience affects your enthusiasm for have more of this type of service. Perhaps the answer for you would be in the future to do less treatment at any one time.

Steven Wallach, MD · Answer

I had one patient a few years ago develop a herpetic outbreak after injection of her lips. The patient denied ever being "exposed" to cold sores. But guess what? Her husband said "Oh yeah, I get them all the time!." She did fine and healed well. I gave her Valtrex, and recommended Valtrex for future treatments.

Francis R. Palmer, III, MD (retired) · Answer

I agree that with fillers and neortoxin injections, the herpetic trigger at the treatment site is 

	What's typically addressed.  I have not heard of shingles being associated with either of these treatments.  Shingles can be along any nerve pathway and the specific facial version is called Ramsey/Hunt Syndrome.

F. Victor Rueckl, MD (in memoriam) · Answer

In general with injectables, herpetic triggers are cold sores and they happen at injection sites, usually and most commonly in the lips. Nearly 70% of people carry the herpes virus, although some will never, ever actually have an outbreak in their lifetime. However, mouth procedures, including dental visits, can trigger herpetic outbreaks commonly. I have never, ever seen a shingles outbreak from any kind of injectable - Botox or filler - and I have been doing these procedures for over 15 years. I advise patients in consents about the possibility for a cold sore after a procedure, but I don't tell them about shingles, because frankly, I've never seen it happen. If I were you, I would contact Allergan at 1.800.433.8871 to report your adverse effect. Also, really, make sure to visit a dermatologist because I've had many patients come in having been diagnosed with shingles over the years, and truly, about 1 in 20 actually have shingles. It's a common misdiagnosis and there are some other possibilities.

	Thank you for your update. I understand why you are still upset and I'm sorry.  I am happy to hear it's NOT shingles and I'm sorry you were diagnosed with that when it wasn't. So, what did the doctor say it actually is, if not shingles? It's probably not a bad idea to see a neurologist if your doctor felt it was something in the nerve pathway that's somehow been affected.

What Do You Know About Shingles Being Triggered in the Trigeminal Nerve As a Result of Injectables and Frequency and Warnings?

Answers (4)