How To Tell If You Have Shingles Without A Rash

Is It Still Shingles If Theres No Rash

Cases of shingles with no rash may be more common than previously thought.

Shingles is practically synonymous with the word rash. In fact, a blistering red rash that begins a few days after the onset of pain is one of the classic symptoms that clinches the diagnosis. But sometimes shingles presents without a rash, a condition called zoster sine herpete , and its important to know how to identify and treat it.

ZSH may actually be more common than previously believed, according to Anne Louise Oaklander, MD, PhD, a neurologist and director of the Nerve Unit at Massachusetts General Hospital. She says it used to be thought of as unusual and suspect. But extensive studies related to the shingles vaccine Shingrix have provided lots of new information about the herpes zoster virus and shingles. As a result, Oaklander says ZSH may end up being the rule rather than the exception.

One of the things that emerged from these studies is the fact that most shingles infections are mild and many are subclinical, she told Drug Topics. The virus is more active than we thought and its re-erupting in a partial way that very often is going to pass unrecognized.

Symptoms Of Zoster Sine Herpete

Zoster sine herpete is not common and can be hard to diagnose as the most common and differentiating shingles rash is not present. Other symptoms of ZSH are similar to regular shingles, which include:

Pain

Shingles is a very painful disease. This pain is typically described as a deep boring or stabbing sensation that is very severe. Because of the impact on the nervous system this pain may have an electric feel to it. In many cases pain will only affect one side of the body and will be localized to a specific area of the skin, though the disease can affect as many as three spinal nerves at a time. As the disease affects the skin, patients may experience a prickling, itching, or numbness on the skin as well.

Flu-like Symptoms

Patients will often develop flu-like symptoms just before the skin lesions appear. This can include body or muscle aches, headaches, mild fever, a general feeling of illness or poor appetite. These symptoms can last as long as 7-10 days. It is important to note that unlike a cold, patients will not develop a runny nose or cough when suffering from shingles.

Movement Problems

• Pain radiating from your spine
• Sensitive to touch

Shingles Or Heat Rash How Can I Tell

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How Do You Prevent Shingles

Vaccination is a safe and effective way to protect against shingles in most people. The shingles vaccine should not be given to people who are immunocompromised.

For more information on shingles immunisation, see Shingles immunisation service.

Shingles is less contagious than chickenpox. The risk of spreading the disease is low if the rash is covered. When the rash has developed crusts, you are no longer infectious.

If you have shingles, you should:

• wash your hands often to prevent the virus from spreading.

Avoid contact with these people until the rash has developed crusts:

• pregnant women who have never had chickenpox or the chickenpox vaccine
• premature or low birthweight babies
• children who have not had chickenpox or the chickenpox vaccine
• people with weakened immune systems, such as people who:
• have had chemotherapy
• are taking other medicines that weaken their immune system
• have had a transplant

Shingles: All You Need To Know

This article was medically reviewed by Dr. Ira Gurland.

Shingles will affect about a third of all Americans at some point in their lifetime. However, while many people have heard of the disease, fewer know much about it. Because shingles is so common and has the potential to produce painful complications, its important for everyone to understand the basics of this viral infection, including its close relationship with chickenpox.

Both diseases have the same origin, but there are important differences. Understanding these distinctions can help avoid confusion:

• Shingles and chickenpox are different infectious diseases, but both are caused by the same virus, called varicella-zoster .
• Chickenpox symptoms are the bodys first reaction to a varicella-zoster infection, presents as a severe skin rash, is more common in adolescence, and is highly contagious.
• Shingles symptoms are the bodys subsequent reaction to the same varicella-zoster infection that reactivates in the body, often many years later. It is more common in adults and presents as a painful rash as it strikes the nerves. You cant get shingles from someone who has shingles. However, you get chickenpox from someone who has shingles if you never had the chickenpox vaccine or chickenpox earlier in life.

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Other Health Problems Due To Shingles

Some people develop other health problems after the shingles rash clears, which include:

Postherpetic neuralgia : This is the most common. Occurring where you had the rash, PHN can cause constant tingling, burning, and pain. For others, the pain comes and goes.

Whether the pain is constant or intermittent, it can go on for a long time. You can have PHN for months, years, or the rest of your life. There is no way to know how long it will last.

The pain caused by PHN can become so severe that it interferes with your life, making everyday activities painful. A musician may no longer be able to play an instrument. Some people cannot walk comfortably. It may be difficult to bathe or get dressed. You may have trouble sleeping.

How to prevent PHN: If you have shingles, you can greatly reduce your risk of PHN by getting treated for shingles within 3 days of developing the rash.

Get treated for shingles within 3 days of developing the rash

Taking antiviral medication within 3 days of getting the shingles rash can: Reduce your risk of developing PHN Ease symptoms of shingles Clear the shingles rash more quickly

Other health problems that can develop after the shingles rash clears include:

• Blindness or loss of some eyesight

Although rare, some people die of shingles.

Treatment can prevent these complications.

You can find out if you have a greater risk of developing shingles at, Shingles: Causes.

Images

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 Shingles Symptoms

Common symptoms of shingles are pain and a rash in a belt-like form that stops at the midline of the body affecting only one side. Symptoms of shingles progress from burning and itching sensations to severe pain at the location of the rash. Early shingles symptoms may include burning, tingling, or a numb sensation on the skin accompanied by headache, upset stomach, and chills.

Later stages include painful fluid-filled blisters that cause severe pain, fever, and severe itching.

Urgent Advice: Get Advice From 111 As Soon As You Suspect Shingles

You might need medicine to help speed up your recovery and avoid longer-lasting problems.

This works best if taken within 3 days of your symptoms starting.

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or .

Get an urgent GP appointment

A GP may be able to treat you.

Ask your GP surgery for an urgent appointment.

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What Are The Signs & Symptoms Of Shingles

Often the first shingles symptoms happen in the area where the rash will appear. A person may have tingling, itching, or pain in this area. When the rash shows up, the pain may be mild or severe.

The rash starts as groups of tiny pimples on one side of the body or the face. Its often in the shape of a band or belt. The pimples change to pus-filled blisters that break open and scab over in about 710 days. The scabs usually heal and fall off about 24 weeks after the rash starts.

Some kids with shingles also may have a fever and a headache, and might feel tired and achy. Rarely, a child has the pain of shingles without the rash. More severe symptoms can happen, but usually in people over age 50.

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Can You Prevent Shingles

In Canada, there are two approved shingles vaccines, Shingrix and Zostavax II. Health Canada recommends that individuals over the age of 50 be vaccinated against shingles, even if they’ve experienced a shingles flare-up before.

You should talk to your health care provider about which vaccine is right for you based on your personal medical history.

With files from Gail Johnson.

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Signs Of Shingles Before The Rash Appears

Before the rash appears, early warning signs of shingles, which may be present, include:

• Itching, burning pain, numbness, tingling in the place where the rash will develop
• Flu-like symptoms such as chills, fever, headache, feeling fatigued or overly tired

After the initial skin complaints develop into the shingles rash, the condition typically lasts for two to four weeks. The pain typically worsens as the rash develops and alleviates as it heals.

S Of The Shingles Rash

If you have a rash of blisters on your skin or a rash that looks like any shown below, see your doctor immediately for a diagnosis. If you have shingles, its important to get treatment, preferably within 2 to 3 days.

If youve had the rash for longer than 2 to 3 days, its still important to see your doctor.

A typical shingles rash

Doctors often refer to this rash as the shingles band because it looks like a band that appears on one area of your body, as shown here.

A rash on one side of the body

A key that you have shingles is that the rash only develops on one side of your body.

Close-up of a shingles rash

The shingles rash often causes a cluster of tiny blisters. You may notice that the skin beneath the blisters is red and inflamed, as shown here.

The rash will also feel painful.

Blistering shingles rash on a man’s chest

Although the rash can begin in one area, you may notice that a few scattered blisters develop in other areas, as shown here.

Shingles rash on the palm of a man’s hand

While shingles tends to develop on your body or face, it can appear anywhere on your skin.

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What Is The Most Painful Stage Of Shingles

Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. As the blisters scab over, the pain usually starts to disappear. In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia.

Hows Shingles Without A Rash Diagnosed

Shingles without a rash isnt common, but it may be more common than previously thought because it often goes undiagnosed. Shingles without a rash is difficult to diagnose based on your symptoms alone.

Your doctor may test your blood, cerebrospinal fluid, or saliva to identify the presence of VZV antibodies. This will allow them to confirm a diagnosis of shingles without a rash. However, these tests are often inconclusive.

Your medical history may provide clues that suggest you have shingles without a rash. Your doctor may ask if youve had a recent operation or if youre under increased stress.

Once your doctor suspects you have VZV, theyll use antiviral medicines such as acyclovir to treat the shingles. They may also prescribe drugs for the pain.

Other treatment will vary based on the location and severity of symptoms.

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Who Should Be Vaccinated With Shingrix

The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.

You should get the Shingrix vaccine even if:

• Youve had shingles already.
• Youve been previously vaccinated with Zostavax . If youve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
• You dont know for sure if youve ever had chickenpox.

Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.

Shingles: Not Just A Band Of Blisters

Topics in this Post

• Infectious Diseases

Shingles is a common condition caused by the chickenpox virus . Not everyone who’s had chickenpox will develop shingles. However, after years of lying dormant in nerve tissue near the spinal cord and brain, the virus can reactivate in some people. As it becomes active again, the virus causes pain, tingling and, eventually, a rash of blisters that doesn’t last long.

The reason for shingles is unclear. But it may be due to lowered immunity to infections as you grow older.

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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:

Medications To Aid Recovery

Medications which may be prescribed for alleviating the physical discomfort of shingles and combating the flare-up of the varicella zoster virus may include:

• Painkilling medications such as non-steroidal anti-inflammatory drugs , paracetamol or opioids in cases of severe pain. In some cases, antidepressants or anticonvulsants may be prescribed for their pain-relieving properties, which can work effectively in combination with other painkillers.
• Antiviral medications

Most people who develop shingles have a tell-tale rash on one side of their body. But its possible to have shingles without a rash. This is known as zoster sine herpete or internal shingles. It is caused by the same virus, varicella-zoster virus , that causes shingles .

While it doesnt produce a painful, itching rash, internal shingles does cause other symptoms. Because it may not be recognized as a shingles infection, the frequency of ZSH infections may be higher than previously thought.

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How Is Shingles Treated

Although a shingles outbreak can last from 3-5 weeks, your doctor can prescribe an anti-viral medication that can help shorten the length of your illness. These anti-viral medications work best when taken at the first sign of outbreak, and can help prevent any long-term side effects of the virus, like long-term nerve pain, known as postherpetic neuralgia.

Aside from anti-virals, your doctor may prescribe pain medication or lotions to help ease the shingles rash itself.

Ringworm Causes An Itchy Red Circular Rash

Ringworm is a skin infection that, despite its name, is caused by a fungus, whereas the shingles rash is caused by a virus, according to the CDC. Ringworm can cause a red, itchy, circular rash on your skin. It may also cause scaly, cracked skin and hair loss. The rash can appear on any part of your body, and it spreads easily through skin-to-skin contact or contact with an item contaminated with the fungus, like dirty clothes or a shower floor. Some forms of ringworm can be treated with over-the-counter medication, while others must be treated with prescription antifungal medication.

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How Long Does A Shingles Outbreak Last

It can take three to five weeks from the time you begin to feel symptoms until the rash totally disappears.