Medical Health Encyclopedia

One form of shingles is known as zoster sine herpes, in which pain occurs first without a rash. Pain is so common to all stages of herpes zoster, in fact, that physicians often refer to all syndromes with a single term, zoster-associated pain (ZAP).

Prodrome (Pain).

• Pain is the primary early symptom for shingles and it occurs in all patients. The pain most often occurs in the skin at the site of the re-activated virus. The pain may be experienced as sharp, aching, piercing, tearing, or similar to an electric shock.
• The affected skin may itch, feel numb, and be unbearably sensitive to touch. Often the patient experiences a combination of these sensations along with pain.
• In addition, some patients may have flu-like symptoms such as muscle aches. (Some people have fever, but it is uncommon.)

The prodrome stage lasts one to five days before the infection becomes active and the skin rash erupts. Occasionally, the pain can last for weeks or even months before the rash erupts.

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Active Shingles. The rash that marks the active infection follows the same track of inflamed nerves as the prodrome pain. Between 50% and 60% of cases occur on the trunk. The second most common side is the head, particularly on one side of the face. It may also erupt on the neck or lower back. If the face is affected, there is a danger that the infection can spread to the eye or mouth. A rash that follows the side of the nose is a warning that the cornea of the eye is endangered.

This is a picture of herpes zoster (shingles) on the neck and cheek. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the "dermatomes" picture).

The active infection is typically marked by the following sequence:

• A rash appears, which starts as well-defined, small, red, clear spots.
• Within 12 to 24 hours, these pimples develop into small fluid-filled blisters.
• The blisters grow, merge, and become pus-filled.
• Pain is common during the active infection.
• Within about seven to ten days (as with chickenpox), the blisters form crusts and heal. In some cases it may take as long as a month before the skin clears completely. Healing takes even longer in patients who have impaired immune systems, and, in such cases, the blisters may persist for up to months.