Also called herpes zoster, shingles is a type of viral infection marked by the occurrence of a rash in the abdominal area and severe pain. Most cases of shingles are identified by the occurrence of the distinctive rash, but it is also possible for the condition to occur without the rash. It may be noted that the rash can affect any part of the body, it usually occurs as solitary band of blisters which covers either the right or the left side of the trunk.
Shingles is caused due to infection by the varicella zoster virus. It is virus which is also responsible for the development of chickenpox. The virus tends to remain dormant in the brain and the spinal cord after the initial infection of chickenpox. It may become active again many years later as shingles.
Shingles is not a dangerous condition, but it can be accompanied by severe pain. Vaccination can help decrease the susceptibility to shingles. Early medical therapy of the condition can reduce the duration of the infection and also decrease the risk to onset of health complications.
Can you have shingles without a rash?
- The distinctive rash spread across the abdomen, neck, and chest region is the most recognizable symptom of shingles. However, there have been several cases when shingles has been diagnosed in people who do not develop the rash. This type of shingles without rash is called as “zoster sine herpete” which means absence of the skin rash despite the presence of all other symptoms of singles in a patient. It is possible for the rash to finally appear about three weeks after the reactivation of the virus and the development of the infection.
- It may be noted that shingles without rash typically affects the elderly, especially those individuals who are older than 75 years. The absence of the distinctive rash can pose problems in effective diagnosis. Most instances of shingles without rash carry an elevated risk of misdiagnosis.
- The intense discomfort in the chest area which may occasionally occur as a symptom of shingles infection may be misidentified as being a respiratory anomaly or a heart attack. A person may be diagnosed as having shingles without rash only after a blood test which confirms the occurrence of the varicella zoster virus.
Symptoms of shingles without rash
The signs and symptoms of shingles tend to affect a small area, usually only on one side of the body. The characteristic strip of blisters may affect one side of the trunk, or sometimes one side of the face or neck, or around one eye. This rash is absent in case of shingles without rash.
A few common symptoms are listed below:
- Numbness, pain, and burning or tingling sensations
- Extreme pain in the area where the rash may have developed. This pain which accompanies shingles without rash does not stay isolated to just the surface of the skin, but tends to go deeper and causes throbbing pain of the muscles.
- Blisters that are full of fluids. They may rupture, discharge fluids, and scab over.
- Itching
- Increased sensitivity and tenderness to touch.
- Uncommonly, some patients may suffer from nausea, fever, chills, photosensitivity, headaches, and fatigue.
Some of the complications associated with shingles include postherpetic neuralgia; increased risk to bacterial infections due to improper or non-treatment of shingles; ocular infection and even vision loss if the area around eyes is infected by the virus; and nerve fiber damage which may trigger neurological conditions such as facial paralysis, balance disabilities, brain inflammation, and hearing defects.
Causes
Shingles is caused due to infection by the chickenpox causing varicella zoster virus. People who have had chickenpox may develop shingles in the future, when the dormant virus becomes active.
The exact cause of such reactivation of the virus is not known, but doctors attribute it to lowered immunity levels that coincide with aging. Shingles without rash is especially prevalent in the elderly with compromised immune systems.
People with shingles can transmit the virus to anyone who does not have chickenpox immunity. The transmission of the virus occurs via direct exposure to the open sores. These sores may occur even when the characteristic striped shingles rash is absent. However, after the transfer of the virus, the person will develop chickenpox and not shingles. Chicken pox can be very harmful for newborns, pregnant women, and people with impaired immune systems. Hence, avoid contact with all, especially the people in high risk group, till the sores crust over.
Listed below are some risk factors which can increase the vulnerability to developing shingles without rash:
- People over the age of 50 years are at greater risk
- Treatment of cancer and other conditions via chemotherapy and/or radiation therapy can increase the threat levels
- Intake of immunosuppressant drugs for curbing the immune system, as well as prolonged use of steroids can increase the risk
- Presence of cancer, HIV/AIDS and other conditions that hamper immune system function can also increase the vulnerability to developing shingles without rash.
Treatment of shingles without rash
There is no cure for shingles. Early detection and prompt treatment can lower the severity of the accompanying symptoms and also help prevent the development of health complications. A few treatment options are:
- Varied drugs such as anticonvulsants, numbing agents, tricyclic antidepressants, and medications with narcotics like codeine as ingredients can help find relief from extreme pain that occurs along with shingles without rash.
- Cool baths as well as cool and/or wet compresses can help ease pain and itching.
- If the rash finally develops, then doctors may prescribe medicines like Valacyclovir, Acyclovir, and Famciclovir to alleviate the symptoms.
The varicella vaccine for chickenpox and the Zostavax vaccine for shingles can help prevent the development of chickenpox and shingles, respectively. However, these vaccines do not guarantee that the person who gets vaccinated will never develop the illnesses. They only help avoid the occurrence of severe cases of shingles as well as lower the risk to health complications. Also, they cannot be used as a treatment option for those who have an underlying instance of shingles without rash.
I have shingles for 5 days but no rash yet. Dr prescribed antiviral tablets. If I don’t develop the rash, should I continue with the medication? What can happen if I keep taking it without the rash?
Thanks for the information and opportunity to ask questions
Kind regards.
Ana Diaz
did you get your answer? I am in same boat, pretty sure my pain is shingles and have not developed the rash. I did have small rash about 4 years ago. Was size of a quarter and thought it was a spider bite. The sore itself did not hurt that much but there was lots of pain in that general area. Now I am having the same pains- 10 very very bad pain in my back by scapula and around in shoulder, armpit and down back of my left arm. I went to doctor and told him I thought it was shingles because the pain seems to be the same. He did not think so but still prescribed the anti viral med you are taking. I just started it last night. My pain is reducing 5 now…I hope it is working..thinking about getting vaccine as well when I get past this pain…I pray for you, I know how bad the pain is- worst pain in my life.
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