Illustration of nerve pathways in an arm affected by shingles, symbolizing herpes zoster paresis.

Unmasking Herpes Zoster Paresis: When Shingles Affects More Than Your Skin

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"A deep dive into the rare but serious complication of herpes zoster (shingles) that can lead to muscle weakness and paralysis, and what you need to know to protect yourself."

Most people know shingles as a painful skin rash caused by the varicella-zoster virus – the same virus that causes chickenpox. After you've had chickenpox, the virus lies dormant in your nerve tissue. Years later, it can reactivate as shingles. While the telltale rash is often the primary concern, shingles can sometimes lead to more serious complications, including a condition known as herpes zoster paresis.

Herpes zoster paresis is a rare but significant complication where the shingles virus affects the motor nerves, leading to muscle weakness or even paralysis in the affected area. This can be a frightening experience, as it goes beyond the typical pain and discomfort associated with shingles.

This article will explore herpes zoster paresis in detail, explaining how it develops, how it's diagnosed, and what treatment options are available. Understanding this potential complication can help you be more proactive about your health and seek timely medical attention if you experience any unusual symptoms during or after a shingles outbreak.

What is Herpes Zoster Paresis and How Does It Happen?

Illustration of nerve pathways in an arm affected by shingles, symbolizing herpes zoster paresis.

While shingles is known for its painful rash, the varicella-zoster virus doesn't just target the sensory nerves responsible for feeling. In some cases, it can also attack the motor nerves, which control muscle movement. When this happens, it can lead to weakness or paralysis in the muscles supplied by those nerves.

The exact reason why the virus affects motor nerves in some people and not others isn't fully understood. However, it's believed that a combination of factors, such as the individual's immune response and the specific strain of the virus, may play a role. The paresis often corresponds to the same area of the skin affected by the shingles rash.

Here’s a breakdown of key points about herpes zoster paresis:

Rare Complication: It's not a common occurrence, but it's a recognized risk associated with shingles.
Motor Nerve Involvement: The virus directly impacts the nerves that control muscle movement.
Weakness or Paralysis: This can range from mild weakness to complete paralysis of the affected muscles.
Location: Often occurs in the same area as the shingles rash, but not always.
Potential for Long-Term Effects: If not treated promptly, it can lead to lasting muscle weakness.

A recent case study highlights the importance of recognizing this condition. A 75-year-old woman experienced arm weakness after a shingles outbreak. The diagnosis was confirmed through detection of the varicella-zoster virus and further testing. This case underscores the need for vigilance and prompt action when neurological symptoms arise during or after a shingles infection.

Taking Action and Seeking Support

If you're experiencing a shingles outbreak, it's crucial to be aware of the potential for herpes zoster paresis. Any signs of muscle weakness or difficulty moving a part of your body should be reported to your doctor immediately. Early diagnosis and treatment are key to minimizing long-term effects. While the prospect of paresis can be concerning, remember that many people recover fully with appropriate medical care and physical therapy. Stay informed, stay proactive, and prioritize your health.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/ced.13846, Alternate LINK

Title: Herpes Zoster‐Associated Paresis Of The Left Arm

Subject: Dermatology

Journal: Clinical and Experimental Dermatology

Publisher: Wiley

Authors: L. Ludriksone, J. Tittelbach, P. Elsner

Published: 2018-12-14

Everything You Need To Know

What exactly is herpes zoster paresis, and how is it different from typical shingles symptoms?

Herpes zoster paresis is a complication of shingles where the varicella-zoster virus attacks motor nerves, leading to muscle weakness or paralysis. Unlike typical shingles, which primarily affects sensory nerves and causes a painful rash, herpes zoster paresis directly impacts muscle function. The varicella-zoster virus, which remains dormant after a chickenpox infection, reactivates and can target motor nerves, causing paresis in the area corresponding to the shingles rash. Prompt recognition and treatment are crucial to minimize potential long-term muscle weakness.

How does the varicella-zoster virus cause herpes zoster paresis, and why are some individuals more susceptible to this complication after a shingles outbreak?

The varicella-zoster virus causes herpes zoster paresis by directly affecting the motor nerves, which control muscle movement, rather than just the sensory nerves that cause the characteristic shingles rash. The exact reason why the varicella-zoster virus targets motor nerves in some individuals isn't fully understood. However, it is believed that a combination of factors, such as the individual's immune response, the specific strain of the virus, and possibly other underlying health conditions, may increase susceptibility. The paresis often occurs in the same area of skin affected by the shingles rash, indicating a localized impact of the varicella-zoster virus on the nervous system.

What are the key signs that might indicate someone is developing herpes zoster paresis during or after a shingles outbreak, and why is early detection so critical?

The key signs of developing herpes zoster paresis include muscle weakness, difficulty moving affected body parts, or even paralysis in the area corresponding to the shingles rash. Early detection is critical because prompt treatment, involving antiviral medications and potentially physical therapy, can significantly improve the chances of recovery and minimize long-term muscle weakness. A delay in diagnosis and treatment of herpes zoster paresis can lead to lasting muscle impairment, making early recognition and immediate medical attention essential.

What treatment options are available for herpes zoster paresis, and what role does physical therapy play in the recovery process?

Treatment for herpes zoster paresis typically involves antiviral medications to combat the varicella-zoster virus. Corticosteroids might also be used to reduce inflammation and nerve damage. Physical therapy is a crucial component of the recovery process, aimed at restoring muscle strength, improving range of motion, and preventing long-term disability. The specific therapeutic exercises and rehabilitation strategies are tailored to the individual's needs and the extent of muscle involvement. Early and consistent physical therapy can significantly improve functional outcomes and quality of life for individuals with herpes zoster paresis.

Beyond antiviral treatment and physical therapy, what additional steps can individuals take to support their recovery from herpes zoster paresis and prevent long-term complications?

In addition to antiviral treatment and physical therapy for herpes zoster paresis, several supportive measures can aid recovery and prevent long-term complications. These include maintaining a healthy diet to support immune function, managing pain with appropriate analgesics, and addressing any underlying health conditions that could compromise recovery. Regular follow-up with healthcare providers is essential to monitor progress and adjust treatment as needed. Individuals should also prioritize rest and stress management, as both can impact the body's ability to heal. While not directly related to herpes zoster paresis management, vaccination against shingles after recovery can prevent future outbreaks and potential complications from the varicella-zoster virus.