Herpes zoster, more commonly called shingles, is a viral disease caused by the herpes vericella virus. This virus is in the same family as chickenpox. Doctors have no trouble diagnosing shingles because there is a rash with blisters that usually goes along with the disease. In rare cases one can have shingles without the rash, this condition is called zoster sine herpete. Doctors have a more difficult time properly diagnosing this type of shingles.
Symptoms of Shingles Without Rash
A typical case of shingles will start on one side of the body. The most common areas are on the back, chest, neck and sometimes the face. Shingles on the face may affect the eyes, this can turn into a serious condition that could lead to vision loss.
Shingles starts with a severe pain somewhere on your body. You may have all general body aches, a headache, fever and chills, nausea and vomiting, and you may feel a tingling and burning sensation where the severe pain is felt. Within three to four days, a rash of blisters will form in a nice little line. These blisters are filled with fluid and should dry up within a week or so.
When shingles occurs without the rash the pain is still felt the same way, on one side of the body or the other. The pain from zoster sine herpete is often extreme and doesn’t just affect the surface of the skin. The pain is felt deep in the muscles and the patient complains of an intense throbbing that is almost crippling in its intensity. Usually zoster sine herpete is localized on the torso, but there are cases where the disease affects the face. This condition is known as Bell’s Palsy; it is a viral infection that attacks the facial nerves. Patients may end up with paralyzed facial muscles. Bell’s Palsy (like most cases of shingles) only affects one side of the face, and is easy to diagnose because the patient is unable to close their eyes or smile properly.
Treatment of Shingles without Rash
Zoster sine herpete is normally a disease the affects people older than 75. Because this age group usually has a lot of heart and lung issues, it is even harder to diagnose zoster sine herpete in these patients. The chest pain that accompanies this condition may be misdiagnosed as a respiratory or heart problem. Only after a blood test will the doctor be able to say for sure that these patients actually have zoster sine herpete. Once the correct diagnosis is made, treatment can begin.
Most of the treatment for shingles, with or without the rash, is directed towards managing the pain. Ibuporfen (Advil), acetaminophen (Tylenol), and tricyclic antidepressants are all used to treat the pain. Antiviral medicines like valacyclovir (Valtrex), acyclovir (Zovirax), and famciclovir (Famvir) help decrease pain and decrease the rash. Pain medication is almost always prescribed because the pain of shingles, with or without the rash, is so intense in some people. Those with the most severe pain may be given a prescription for morphine, oxycodone, or amitrypline which helps fight the most extreme pains.