Zoster Sine Herpete: What If Shingles Doesn’t Erupt?

According to the Centers for Disease Control and Prevention, shingles strikes one million Americans each year. The best known for shingles characteristic is the blistering skin rash. Occasionally, it doesn’t produce skin manifestations at all, this condition is called “zoster sine herpete.” People with zoster sine herpete develop all the characteristic symptoms of shingles except the rash.

Like classical shingles, zoster sine herpete can affect the spinal or cranial nerves that supply motor function to the muscles of the body and face. The common presentation is weakness in one arm or leg or one side of the abdomen or the diaphragm muscles which control breathing. When the cranial nerves become involved, the result is Ramsay-Hunt syndrome. Ramsay-Hunt syndrome will cause facial muscle palsies that often result in marked asymmetry. People lose the ability to close or open one eye and one side of the mouth falls slack. Zoster sine herpete causes all of the same symptoms, patients with zoster sine herpete face additional diagnostic tests, delayed diagnosis and misguided interventions due to the unusual presentation of their disease.

Some people with zoster sine herpete report the gradual onset of flu-like illness on or shortly before the time that lesions would erupt. There are common complaints include fever, usually mild, headache, muscle or body aches, poor appetite and generalized malaise, that can last for seven to ten days. People often attribute the symptoms to a mild case of the flu or a cold, but in the case of shingles, respiratory symptoms of flu or colds do not develop with zoster sine herpete.

According the National Shingles Foundation, the varicella-zoster virus causes zoster sine herpete and other types of shingles. It is the same virus that responsible for chickenpox. After recovering from chicken pox, the virus lies dormant in body but can reappear as shingles.

Shingles, or herpes zoster, is an outbreak of rash or blisters on the skin and occurs in a band or cluster on one side of the body. However, with zoster sine herpete, there is no rash or blister outbreak, but the other symptoms of shingles still affect the patient.

The National Shingles Foundation explains that shingles is not contagious and it occurs in a person who has had chickenpox previously. Antiviral medications can treat a shingles outbreak but work best when the patient starts taking them within the first couple of days of infection. Due to the lack of a rash with zoster sine herpete, the patient may not realize that he has a form of shingles and may delay seeking treatment.

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