Shingles without a rash is calledzoster sine herpete(ZSH) or internal shingles.
Even without a rash, you may still experience pain and itching.
You may also have a headache, fatigue, nerve pain, and numbness.
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Treatments aim to manage these symptoms.
Oscar Wong / Getty Images
What Causes Shingles Without a Rash?
When it reactivates, it causes shingles.
That generally means symptoms develop in a stripe on one side of your body.
However,disseminated zostermay affect multiple nerves in immunocompromised individuals.
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.
Who Is at Risk for Shingles?
Arashthen appears within several days.
The pain can be mild to severe and may interfere with everyday activities.
How Long Shingles Lasts
Without treatment, shingles should only last three to five weeks.
It can clear up much faster with treatment, especially if caught and treated early.
This can lead to the continuous activation of the VZV.
With PHN, pain continues even after shingles is gone.
It can produce lifelong effects that interfere with your quality of life.
Other potential complications include:
Diagnosis
ZSH is often misdiagnosed because of the lack of rash.
A lab test can help diagnose a ZSH infection.
This is especially helpful for detecting the virus when you don’t have conventional symptoms.
A direct fluorescent antibody (DFA) test is sometimes used but it’s not as sensitive as PCR.
Your healthcare provider may perform multiple tests to rule out possible causes of your symptoms.
Treatment
Research on ZSH treatments is limited.
However, the typical treatment involves antiviral medications such as Valtrex (valacyclovir) or Zovirax (acyclovir).
Pain management is also an essential part of treating internal shingles.
Some drugs that may help with nerve pain include:
Lesions and complications should also be treated.
The discomfort may disrupt your life and make it hard to sleep.
It can also cause depression.
You may want to ask your healthcare provider about asleep aidor antidepressants.
If you’re struggling to cope, talk to family and friends about what you’re going through.
Summary
Internal shingles doesn’t involve a rash like typical shingles.
This is because it affects nerves that are deeper in the body and don’t connect to the skin.
It still causes an itch and severe pain, and may even be more painful than a shingles rash.
This delays treatment and can lead to complications such as postherpetic neuralgia.
Internal shingles is treated with antivirals and a variety of medications that help control pain.
You may benefit from antidepressants and sleep drugs as well.
A support group may help you cope.
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