What Are The Symptoms Of Shingles Without A Rash
The symptoms of ZSH are similar to the symptoms of shingles, but without a rash. The symptoms are usually isolated to one side of the body and commonly occur on the face and neck, and in the eyes. Symptoms can also occur in the internal organs. Typical symptoms include:
Shingles isnt contagious. You cant give someone else shingles. If you have shingles and are in contact with someone who hasnt had chickenpox or wasnt vaccinated for chickenpox, you can give that person chickenpox. That person would have to come in direct contact with your shingles rash.
If you have shingles without a rash, you shouldnt be able to pass it to others. Still, its a good idea to avoid contact with people who havent had chickenpox as well as pregnant women until your other symptoms have cleared up.
You can only get shingles if youve had chickenpox in the past. Youre at an increased risk for shingles if you:
- are over age 50
Can Shingles Be Prevented
Shingles vaccine
In May 2006, the Food and Drug Administration approved a VZV vaccine for use in people 60 and older who have had chickenpox. In March 2011, the FDA extended the approval to include adults ages 50-59. A new shingles vaccine called Shingrix was licensed by the FDA in 2017 for adults age 50 and older. Talk with your healthcare professional if you have questions about shingles vaccination.
The Shingles Prevention Studya collaboration between the Department of Veterans Affairs, the National Institute of Allergy and Infectious Diseases, and Merck & Co., Inc.involved more than 38,000 veterans aged 60 and older. The purpose was to find out how safe the vaccine is, and if it can prevent shingles. Half the study participants received the shingles vaccine, and half received a similar looking, inactive vaccine . Neither volunteers nor researchers knew if a particular subject had gotten active or placebo vaccine until after the end of the study . During more than 3 years of follow-up, the vaccine reduced shingles cases by 51 percent 642 cases of shingles developed in the placebo group compared with only 315 in the vaccinated group. And in people who received the active vaccine and still got shingles, the severity and discomfort were reduced by 61 percent. The vaccine also reduced the number of cases of long-lasting nerve pain by two-thirds compared with the placebo.
Chickenpox vaccine
Focus On Prevention Doctors Say
Prevention is the best way to avoid a shingles episode.
There is a vaccine that prevents the onset of shingles in people exposed to chickenpox. The CDC recommends that people age 60 and older get one dose of the vaccine. Vaccines are readily available at a doctors office and drug stores. In 2011, the Food and Drug Administration extended the vaccine use for people aged 50 to 59.
Wigand-Bolling said the vaccine reduces the incidence of shingles by 51% and the neuralgia associated with shingles by 67%. The doctor said the vaccine is injected and once vaccinated a person is protected for life.
Unless contraindicated because of pregnancy or being an organ transplant recipient or on chemotherapy, everyone over age 50 should be vaccinated, Wigand-Bolling said. I would recommend getting vaccinated to patients who may not have had chicken pox, or those who dont remember having chicken pox.
More than 90% of those identified in the study at increased risk of stroke and heart attack after a shingles episode hadn’t been vaccinated for shingles. The people in the study who had the vaccine still got shingles, it’s worth noting.
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How Dangerous Is Shingles
Shingles isnt considered a dangerous health condition.
Each year about 1 million new cases of shingles are reported in the United States. Most people recover and resume their normal activities once theyre no longer infectious.
However, if shingles isnt treated, particularly severe cases can lead to death.
People with autoimmune conditions and people over the age of 65 are at a higher risk for shingles complications.
Women who are pregnant may also be concerned if they develop shingles. You and your baby will most likely be safe. However, talk with your healthcare provider if youre pregnant and suspect you have shingles.
Why Two Types Of Shingles
Most people are infected with VZV at some point. This type of virus stays in your body forever, but it lies dormant most of the time. When it reactivates, it causes shingles.
The infection affects a single nerve and the itching and pain are confined to the path of that nerve. That generally means symptoms in a stripe on one side of your body.
Typical shingles develops from an infection in a sensory nerve
In internal shingles, the infected nerve is deeper in the body, often in the digestive organs. It doesn’t cause a rash because those nerves don’t connect to your skin.
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What Are The Symptoms Of Shingles
Usually, shingles develops on just one side of the body or face, and in a small area. The most common place for shingles to occur is in a band around one side of the waistline.
Most people with shingles have one or more of the following symptoms:
- Fluid-filled blisters
- Tingling, itching, or numbness of the skin
- Chills, fever, headache, or upset stomach
For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze. Its important to talk with your doctor if you notice any shingles symptoms.
If you notice blisters on your face, see your doctor right away because this is an urgent problem. Blisters near or in the eye can cause lasting eye damage and blindness. Hearing loss, a brief paralysis of the face, or, very rarely, inflammation of the brain can also occur.
Is Treating Relapse The Same
The approaches to treating shingles and any relapse are the same. In the latter case, healthcare providers may become particularly interested in isolating the cause of the weakened immunity thats causing the recurrence. That said, there is no outright cure for this disease, so treatment focuses on managing symptoms.
These approaches include:
- Antiviral medications, such as Zovirax , Famvir , and Valtrex , can help, especially if given within 72 hours of symptom onset.
- Over-the-counter drugs like Tylenol or Motrin or Advil can also help manage discomfort and pain.
- Compresses and creams are among other approaches that help relieve itching these include applying wet compresses, using calamine lotion, and taking colloidal oatmeal baths.
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How Can I Learn About Or Participate In Clinical Research
- Clinical trials are research studies on humans that are designed to answer specific questions about vaccines or new therapies, to test new ways of using known treatments, or to find out more about a disorder. Clinical studies and trials involving the zoster virus and postherpetic neuralgia may lead to better understanding of shingles and identify potential treatments. Both healthy individuals and people with disorders are needed to advance the understanding of diseases and how to treat them. For more information about clinical trials and how you may participate in a study, see
- ClinicalTrials.gov provides information about ongoing and completed federally and privately supported clinical studies for a wide range of diseases and conditions, including shingles.
- NIH Clinical Research Trials and You provides information about clinical trials, why they matter, and how to participate, including links to search for a trial or enroll in a research matching registry.
Higher Intensity Of Pain With Internal Shingles
While both regular shingles and internal shingles can cause preherpetic neuralgia, this condition has been found to be more severe in the latter case.
One study found that at the onset of symptoms, after one month, and after three months, internal shingles patients had consistently more severe and persistent pain. Overall, however, preherpetic neuralgia occurs much more frequently in regular herpes zoster patients.
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Shingles And The Battle Of The Bulge
I thought I knew herpes zoster inside and out from patients experiences, my late mothers herpes zoster ophthalmicus , to my recent vaccination with Shingrix. I just became cognizant of a new complication of HZ the post-herpetic abdominal pseudohernia .
Following primary varicella infection, the varicella-zoster virus persists in spinal and cranial nerve ganglia. After reactivation and replication, the virus traverses through sensory nerve fibers associated with the involved ganglion resulting in its classical dermatomal vesicular eruption.
Neurologic complications of HZ are legion, with post-herpetic neuralgia being the most common. Meningoencephalitis, myelitis, cerebrovascular accidents due to cerebral vasculopathy, paresis, and paralysis are potential complications. The Ramsay-Hunt syndrome is defined as HZ oticus associated with peripheral facial nerve paresis other cranial nerves may also be affected. The involvement of the geniculate ganglion in RHS leads to a multiplicity of combination of sensory abnormalities , motor problems , or disturbances of lacrimal and nasal secretion.
Motor complications of HZ are infrequent, affecting 1-5% of cases. Development of mononeuropathies other than facial nerve palsy are rare.
The differential diagnosis of abdominal bulges includes a hernia or tumor , all of which may be detected by imaging. Pseudohernias should also be considered.
How Do You Prevent Internal Herpes Zoster
You can prevent it by the herpes zoster vaccine. Experts recommend that people take the inoculation when they get to 60 years. However, if they take it past 70 years, the vaccine may not work as required.
The Centers for Disease Control and Prevention recommend that people get the shingrix vaccine if they are healthy. However, if they are unsure whether they had chickenpox or have previously taken the herpes zoster vaccine known as the Zostavax they should avoid it.
Even though vaccines undergo rigorous safety testing, they are not usually suitable for everyone.
Individuals should avoid taking shingrix during the following circumstances:
- If they have a fever of 101.3F or any severe illness.
- If they already have had an active herpes zoster infection.
- If they have an allergic reaction to shingrix or any of its ingredients.
- If they are currently pregnant or breastfeeding mothers.
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How To Decrease Your Risk Of Complications
Treating shingles early can help shorten the lifespan of the virus.
If youre able to shorten the infection, youll decrease your risk for complications from the virus. Antiviral medication is recommended as a first line of treatment when youre diagnosed with shingles.
Getting a varicella vaccination can help you to avoid contracting shingles and chickenpox. Even if youve already had shingles, a vaccination against shingles can help to prevent the virus from reactivating in your system.
The most common complication associated with shingles is postherpetic neuralgia . PHN is long-term nerve pain that can occur in the area where your shingles rash appeared.
According to the Centers for Disease Control and Prevention , of people experience PHN after a shingles outbreak.
The older you are when your shingles appears, the higher your risk for long-term nerve pain.
If the virus is left untreated, your risk for other complications related to shingles
Duration Will Vary For Each Person
Its important to know shingles duration last because you dont want this condition to negatively impact your life. If left untreated, it can lead to other complications like PHN or blindness.
However, if taken cared of properly and treated immediately with antiviral medication, shingles last should only be about six weeks.
Vaccines against shingles are also available and widely proven to be effective. Shingrix is an FDA-approved vaccine that effectively reduces the risk of getting shingles by up to 97%.
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What Is Postherpetic Neuralgia
Sometimes, particularly in older people, shingles pain persists long after the rash has healed. This is postherpetic neuralgia, defined as pain lasting three months after onset of the rash. Pain can be mild or severethe most severe cases can lead to insomnia, weight loss, depression, and disability. There may be other sensations, such as tingling, coldness, or loss of feeling. About 20 percent of people age 70 or greater who develop shingles may have long-lasting pain. Postherpetic neuralgia is not directly life-threatening and may get better over time.
About a dozen medications in four categories have been shown in clinical trials to provide some pain relief for postherpetic neuralgia. These include:
Tricyclic antidepressants : TCAs are often the first type of drug given to people suffering from postherpetic neuralgia. The TCA amitryptiline was commonly prescribed in the past, but although effective, it has a high rate of side effects. Desipramine and nortriptyline have fewer side effects and are therefore better choices for older adults, the most likely group to have postherpetic neuralgia.
Common side effects of TCAs include dry eyes and mouth, constipation, and impaired memory. People with heart arrhythmias , previous heart attacks, or narrow angle glaucoma should usually use a different class of drugs.
Postherpetic itch
First Signs Of Shingles
The first few signs usually include a tingling, burning or itching sensation in the area where the rash will develop. If you have any of these symptoms, its important to see your doctor right away for diagnosis and treatment.
Shingles can manifest a variety of symptoms at the outset. These might be as mild as irritated skin and discomfort to severe fever, along with other signs of significant sickness.
Shingles often persists for 3 to 5 weeks. The first few days may go by without any rashes being seen. Early symptoms might include:
- pain on just a single side of the body, such as burning or pinching
- stomach issues, including vomiting and diarrhea
- a sensation of numbness, tingling, or shooting pains on only a single side of the bodys skin
- feelings of sickness and fatigue
People who are experiencing the symptoms above and have had chickenpox in the past should be carefully examined to confirm that they may be suffering from shingles. Its more likely to be shingles if a person has several risk factors for the disease.
A red rash appears one to five days after the onset of skin tingling and burning for most people. The rash typically transforms a few days later into tiny fluid filled bubbles. After the fluid inside the rash has dried, crusty blisters form seven to ten days later. The scabs should disappear in a few weeks time.
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If My Shingles Rash Is Mild Or Has Mostly Healed Do I Need To See A Doctor
Its a good idea to see a doctor whenever you have a case of shingles, no matter how mild.
Prompt antiviral treatment not only decreases the duration and severity of the rash but can also decrease the chance of developing post-herpetic neuralgia. Post-herpetic neuralgia is a complication of shingles characterized by long-term, debilitating pain.
If your rash has mostly healed, its still a good idea to see a doctor so they can monitor the rash for changes or complications, such as a bacterial skin infection that forms on top of your existing rash. This is known as a superimposed infection.
Zoster Sine Herpete Is A Rare Form Of Shingles That Doesn’t Cause A Rash
Most people with shingles have a telltale rash on one side of their body, but it is possible to have shingles without a rash. It’s called zoster sine herpete or internal shingles. It’s caused by the same virus, varicella-zoster virus , that causes chickenpox and typical shingles .
Internal shingles still causes pain and itchingjust without the rashalong with other symptoms. Because healthcare providers may not recognize it as a shingles infection, ZSH infections may be more common than previously thought.
This article explores the differences in symptoms, the additional complications ZSH can cause, how it’s diagnosed and treated, and how you can cope with it.
Getty Images / Oscar Wong
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Doctor Shares Signs And Symptoms Of Shingles
PRESQUE ISLE, Maine –
A childhood illness can lead to serious health issues for some adults. In this weeks Medical Monday, Kathy McCarty has more on shingles and whos at risk.
Many of us have had chicken pox, most often as a child. But did you know that chicken pox can lead to a person getting shingles as an adult? Dr. Robert McFadgen says theyre both caused by the varicella virus.
When you first get infected with the virus that causes chicken pox, the virus then lays dormant in your nerve cells for years – forever. And then as your immune system that you now – off with the first infection wanes over time, you can get a reactivation, but the second time it comes in the form of shingles, says Dr. Robert McFadgen.
Shingles typically develop as a painful rash.
Often you can get the pain before a rash, or you can get the rash before the pain. It comes out very specifically along one nerve room. So you get a rash only along one part of your rib cage, along one side of your face, etc., says Dr. McFadgen.
Untreated, shingles can lead to severe pain for some. Age is the biggest factor in developing shingles, especially those over 50.
He says, Having a poor immune system, of course, or any kind of chronic conditions, can also increase that risk of reactivation. Other things would include diabetes, heart disease, lung disease, and kidney disease. Those people tend to be at higher risk for reactivation and worse infection, which also worsens with age.
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