Medical Health Encyclopedia

Zoster Sine Herpete. Sometimes pain develops without a rash, a condition known as zoster sine herpete. This usually occurs in elderly patients. Symptoms include burning or shooting pain, numbness, tingling, itching, headache, fever, chills, and nausea. An accurate early diagnosis of shingles in such cases is often difficult. Some evidence suggests that some cases of Bell's palsy (in which part of the face becomes paralyzed) might actually be an indication of zoster sine herpete.

Postherpetic Neuralgia. Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes zoster. (Some experts define persistent pain as subacute herpetic neuralgia if it last between one and three months and as PHN if it lasts beyond three months.) PHN occurs in approximately 10% to 20% of shingles patients.

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Risk for Recurrence of Shingles. Shingles can recur, but the risk is low (about 1% to 5% chance). There is some evidence that a first zoster episode boosts the immune system to ward off another attack. To support this, some elderly people with zoster who are exposed to children with chickenpox appear to have extra protection against a second zoster attack. Note: in people with impaired immune systems, such as those with AIDS, such a booster effect does not occur, and these patients are at particular risk for multiple recurrences of shingles.