Zoster Sine Herpete : Shingles Without The Rash
It is possible for a person to develop shingles without being affected by the rash, although this is rare. When shingles occurs without the rash being present, this is called zoster sine herpete .
When shingles occurs without a rash, the first symptoms of the condition may involve:
- A feeling of numbness in a certain area
- An itchy, burning sensation
- Generalized aches
- Hypersensitivity to touch
When shingles is present, even without the rash, sensations will be concentrated in a specific area of the body â commonly the face, neck, one side of the torso or the eyes. However, in the absence of the shingles rash, zoster sine herpete may still rarely lead to neurological and visceral diseases, such as inflammation of the brain , Varizella pneumonia, paralysis of the facial nerves and problems related to keeping oneâs balance or problems with hearing.
Because shingles shares characteristics with many other conditions, including herpes simplex, impetigo, dermatitis herpetiformis and contact dermatitis, it can easily be confused with these conditions. In cases where a rash is not present, a laboratory test will usually be necessary to establish the presence of the varicella zoster virus in the body.
How Does It Occur
If you have had chickenpox, you are at risk for later developing shingles. After you recover from chickenpox, the chickenpox virus stays in your body. It moves to the roots of your nerve cells and becomes inactive . Later, if the virus becomes active again, shingles is the name given to the symptoms it causes.
What exactly causes the virus to become active is not known. A weakened immune system seems to allow reactivation of the virus. This may occur with normal aging, immune-suppressing medicines, or another illness, or after major surgery. It can also happen as a complication of cancer or AIDS or treatment of these illnesses. Chronic use of steroid drugs may trigger shingles. The virus may also become active again after the skin is injured or sunburned. Emotional stress seems to be a common trigger as well.
What Does Shingles Feel Like
Burning or tingling pain in a small section on one side of the body is typically the first sign of shingles. For some people it can be so intense that even the slightest touch can cause severe pain.
A chickenpox rash often occurs all over the body, whereas a shingles rash usually affects one area. It often strikes on the torso, wrapping your waist in a band-like stripe, or can occur on your face. It looks like fluid-filled blisters.
Other shingles symptoms include itching or numbness. Shingles can also cause fever, headache, and fatigue.
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Spinal Cord Or Peripheral Nerve Stimulation
These are often used to treat several different types of neuropathic pain. Electrodes are placed underneath the skin along the affected peripheral nerves. Before using this technique, doctors will do a test using a wire electrode to get a sense of how the patient will respond.
After the electrodes have been placed above the peripheral nerve, a weak electrical current is sent to the nerve. By stimulating a sensory pathway that doesnt cause pain, experts believe that this electrical signal to the brain can trick the brain into turning off the painful signal, bringing relief to the patient.
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How Did I Get It? Can I Give It to Someone Else? Only people who’ve had chickenpox can get shingles. On the other hand, being around someone with shingles is a risk only for people who’ve never been exposed to chickenpox if they contract the varicella-zoster virus, they’ll develop chickenpox, not shingles. This poses a particular concern for pregnant women chickenpox early in pregnancy raises the risk of birth defects, while a late-term infection increases the risk of delivering a severely ill infant.
Though shingles is seen most often in older people, it can occur at any age, and 10 to 20 percent of people will develop shingles during their lifetime. Up to 50 percent of people age 80 or older can expect to have at least one episode of shingles.
What Causes Shingles Pain? Pain is the greatest problem with shingles. Postherpetic neuralgia, or PHN, is the term used to describe the pain after the rash has faded. PHN may develop days, weeks or even months after the rash heals. People with PHN suffer from three types of pain:
- constant aching or burning
- lancinating pain
This pain can be accompanied by loss of sensation in the affected area. Most patients report an increase in pain after exposure to cold, but not to heat. Some report numbness or tingling.
Treatment The key to the treatment of shingles is to make the diagnosis early. This is difficult because the severe pain may come before the rash by a few days.
When the Pain Persists
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Long Term Side Effects
In rare cases, the live shingles vaccine, Zostavax, can cause a skin rash or shingles.
The rash that occurs with shingles can affect any area of the body, but it often appears as a line of blisters that wraps around the torso.
Within a few days the blisters cluster, and they continue to form for several more days. The blisters can take 2â3 weeks to heal, according to the American Academy of Dermatology.
Other common symptoms of shingles include:
two shingles vaccines for adults: the recombinant zoster vaccine and the zoster virus vaccine .
Prevention Of Armpit Pain
Theres no proven way to prevent breast cancer or lymphatic disorders. But getting annual exams can help you get diagnosed early.
Other causes of underarm pain may be avoidable with a few precautions. For instance, you can prevent a pulled muscle by stretching and not pushing yourself beyond your abilities in the weight room.
Other less serious skin problems, like contact dermatitis, can be prevented by switching deodorants, antiperspirant products, or detergents that might be bothering your skin.
In general, you want to practice good skin hygiene in areas that can trap oil, sweat, and dirt. Keep your armpits clean and dont wait to see a doctor if you notice a rash or other problem.
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What Is Postherpetic Neuralgia
Postherpetic neuralgia is a complication of shingles infection . Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox.
Shingles causes a painful, blistering rash and other symptoms. The rash most commonly occurs in a band pattern on one side of your body, usually on your trunk . The rash turns into blisters. As the rash/blisters go away, pain may remain. When pain remains, the condition is called postherpetic neuralgia.
What Causes Internal Shingles
The varicella zoster virus causes shingles. Its the same virus that causes chickenpox. After a bout of chickenpox, the virus becomes dormant in the body and settles in certain nerves and tissue of the nervous system. Later in life, the virus can reactivate and present itself as shingles. Shingles typically appears on the skin along the nerve path where it had been previously dormant. If the reactivation of the virus becomes severe, it can affect not only the skin but other organs too. This is what is called systemic or internal shingles.
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Week Four: Healing Scabs
Most people with shingles do not develop a blister-related infection. Instead, scabs appear once the blisters dry up and crust over. That typically occurs seven to 10 days post-blistery outbreak, according to the Centers for Disease Control and Prevention. Its important to remember that until scabs appear, your blisters contain the virus, which can cause others to catch the chickenpox. Its also important to continue to wash the area with a fragrance-free cleanser daily until the rash, blisters and scabs are completely clear. Within a month, your skins appearance will most likely return to normal, though some people are left with darker or lighter spots where the shingles rash occurred.
Rebooting The Nervous System
Its like restarting a computer, Dr. Rosenquist says. When its running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully, it will send an appropriate transmission as opposed to a pain transmission.
Treatmentoptions for PHN patients include:
Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.
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First Signs And Symptoms Of Shingles
Among the systemic symptoms that may appear in the first few days of the prodromal stage of shingles are:
- Pain in a specific, localized area of the body
- Sensitivity to light
The most telling first symptom of shingles typically is the pain. Often excruciating, the discomfort has been described as burning, stinging, tingly, prickly, itchy, numbing, achy, or shooting. It can be persistent or intermittent, but will always be limited to one side of the body.
Because the pain from shingles is localized, it can be mistaken for other conditions depending on where it’s focused.
For example, a stabbing or persistent pain on one side of the lower back may mistakenly be attributed to sciatica or a kidney problem. Shingles pain around the lips could suggest a cold sore coming on, while pain focused on the eye or ear might seem like the start of a migraine.
What Are The Symptoms Of Postherpetic Neuralgia
Common postherpetic neuralgia symptoms include:
- Burning, sharp, jagging or aching pain in the area where the shingles rash appeared.
- Itchiness or numbness at or near the area of the former rash.
- Pain that is constant or comes and goes. Pain typically lasts, on average, for three months after the rash has healed, but can last for more than a year or longer.
- Pain at affected skin area can be brought on even with a light touch .
- Pain gets worse at night or in heat or cold temperatures.
Who Should Get The Shingrix Vaccine
The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if:
- Youve had shingles.
- Youre not sure if youd had chickenpox .
- Youve already had the Zostavax vaccine. This vaccine for shingles is no longer available in the U.S. Ask your healthcare provider about the best time to get the Shingrix vaccine.
If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.
How Do Shingles Reactivate In The Nervous System
The shingles virus stays dormant in the nerve tissues. If your immune system grows weaker, the virus reactivates.
As the virus becomes active, it spreads through the spinal cord nerves to the skin. These nerves convey messages of pressure, itching, and pain.
These messages transfer from the spinal cord to the brain. Once the varicella-zoster virus gets to the nerve endings, it shows up as a skin rash.
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Can Shingles Affect Your Joints
Shingles is a blistering, painful skin rash that is common among older adults. It can cause pain in different areas of the body. If you are experiencing joint pain, it could be associated with the onset of shingles.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
What You Can Do About Nerve Pain That Lingers After Shingles
Chronic pain that continues after a case of shingles is called postherpetic neuralgia . It is estimated that about 20% of patients will experience this type of nerve pain as a complication of shingles.
Those who have had chickenpox are at risk of developing shingles later in life. People who develop PHN are generally age 60 and older. Although there is no cure for PHN, there are several methods of pain management that can ease symptoms. Fortunately, the type of pain that arises from postherpetic neuralgia improves over time.
Neuralgia affects the nerves, causing structural and functional damage. It can feel like a stabbing or burning pain that radiates along the affected nerve.
Neuropathic pain is not caused by an external injury or stimuli but originates from inside the nervous system. When the herpes-varicella zoster virus is reactivated in the form of shingles, scar tissue forms alongside nerves, creating pressure, and sending pain signals to the brain.
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How Is Internal Shingles Treated
Even though shingles is a virus, this is a case where there are antiviral medications available by prescription. Thats why its important to see your doctor right away if you suspect you have shingles. Early treatment may reduce the risk of complications, like PHN. Serious complications require hospitalization.
Common antiviral medications for shingles include:
Depending on the location and severity of the shingles infection, steroids may also help. Anti-inflammatory medications like ibuprofen and pain-relieving medication such as acetaminophen or other prescription pain medication can help in easing pain experienced from shingles.
How Long Does Postherpetic Neuralgia Last
Postherpetic neuralgia can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.
The pain from PHN can be so severe in some people that it disrupts their life. Researchers dont know why some people have severe or long-lasting pain and others do not.
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What Are The Symptoms Of Shingles
Two to four days before the shingles rash occurs there may be tingling or local pain in the area. Pain is usually the first sign of shingles. For some, the pain can be intense. In some cases, and depending on the location of the pain, shingles can be mistaken for problems with the heart, lungs, or kidneys. Furthermore, patients may also experience headaches, fever, dizziness, sensitivity to light, and flu-like symptoms without a fever. And, there are cases where some patients experience shingles pain without ever developing the rash.
As time progresses, tingling, itching, joint pain, swollen glands, and a burning pain often develops. The rash typically appears one to five days after the symptoms begin, starting with small, red spots that form blisters filled with fluid, and then scab over. If the blisters burst from scratching, the skin may scar after the rash subsides.
The shingles skin rash usually heals within two to four weeks however, some people develop ongoing nerve pain that can last for months or years, a condition called postherpetic neuralgia.
The rash caused by shingles is more painful than itchy, with the pain and rash being the most obvious signs of shingles. The skin rash tends to be isolated to one side of the body, or in a particular location on the body. Shingles most commonly develops in the areas of the chest, stomach, spine, face, and mouth, but can appear other places on the body, even in multiple locations.
Myth #: Shingles Is Very Rare
Fact: In the United States, about one million individuals get shingles every year. Half of the population who lives to 85 years of age will experience shingles during their lifetime. You have a greater chance of getting shingles as you get older. As the population ages, even more people will get shingles every year.
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Are Shingles Contagious
Though shingles itself is not passed from person to person, the virus that causes shingles can be. The risk of a person with shingles spreading the virus is low with the rash covered.
Shingles spreads during the blister-phase of the rash. Once the blisters and rash have crusted over the person is no longer contagious.
People who develop shingles typically only have one episode in their lifetime, though having more than one shingles outbreak is not unheard of. The Centers for Disease Control recommends the shingles vaccination for anyone over the age of 60 to help reduce risk.
Shingles And Your Eyes
If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.
Shingles painand other symptoms from an outbreak of herpes zosterusually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, its called postherpetic neuralgia .
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What Does The Shingles Rash Look Like
The varicella zoster virus which causes shingles lies dormant in the nervous system, so the rash will appear in a dermatomal pattern a band or area of skin on the body corresponding to a particular set of nerves. The shingles rash usually appears on the face, neck or one side of the torso.
Good to know: If the relevant nerves are affected, it is also possible to experience shingles on the leg. It is relatively unusual, but also possible, to develop the shingles rash in more than one area of the body, i.e. in relation to more than one set of nerves. Even more rarely and especially in people with a compromised immune system, three or more dermatomes may be affected. This is a form of the condition known as disseminated zoster.
As the condition progresses, the rash site develops blisters which fill with clear fluid. Because shingles interacts with a personâs nervous system, the rash is often accompanied by an intense, stabbing pain which worsens as it develops. The area affected by the rash may be hypersensitive to touch, which can render it difficult to dress or to sleep in certain positions.
A person with shingles is contagious to others in the period when their rash is blistering. During this period, a person should avoid physical contact with others, in particular, certain population groups, including:
- People with a weakened immune system
- People who have not had chickenpox in the past