Shingles without the zosters?

[question]

My mom has all the systems of shingles - pain, burning sensation, feels like somethings running up her back, & itching, localized on the left side of her back. It's been going on for six weeks and is just beginning to diminish. She had chicken pox as a child. Can you have herpes zoster without exhibiting the blisters or rash? She felt tired and a general malaise when it first began. Is there such a thing as sans zoster ? Help, please. Thank you.

[Dr. Anthony Solomon]

Shingles, also known as herpes zoster, is a reactivation of the varicella zoster virus which causes chicken pox. You must have suffered from chicken pox to be a prospective candidate for herpes zoster.

The rash in shingles is an important entity in the diagnosis of the disease and is usually associated with moderate to intense pain in the dermatome affected. The rash is characteristically scattered within the dermatome of the body segment affected as groups of vesicles on a red base. Even mild cases will exhibit the typical rash. I have not heard of sans zoster - please tell me if you found that terminology in a medical book.

Dr Anthony Solomon
Consultant Physician, Tropical & Genitourinary Medicine

[question]

I went to see Dr. O'Donahue in Oak Brook, IL 8 days ago because it appeared that I might have shingles on my lower back and traveling around my right side to my hip. It has been quite itchy, but hasn't been especailly painful. Both Dr. O'Donahue and an associate looked at my rash and neither could decide if it actually was shingles or not. I had also been weeding my garden earlier in the week. They suggested I take valtrex (sp?) for 2 days while I observed the rash to see where it spread. It had already spread to my right hip, but not in a continuous line. It's more sporadic. (I, in fact, had shingles 24 yrs. ago while 4 mos. pregnant with my 3rd child. It went around my back to my right armpit and then down to my elbow. Hurt like heck, but went away after about 7 weeks.) The rash and blisters I currenty exhibit look like shingles, but as I wrote, they don't have the same shooting pains I had 24 yrs ago. Rather, it's a more localized, mild- burning, sensation. Somewhat itchy, also. Anyway, I've been putting anti-itch cream on my mother's back for the past 6 weeks as she has all the symptoms of shingles without the actual rash or ensuing blisters. While I was talking to Dr. O'Donahue, I asked her if my mom could have shingles without the rash. She said it's rare, but yes, it's possible. It's called sans zoster. I think I'm accurate in stating that Dr. O'Donahue was, and may still be, Head of the Dermotology Dept. at Loyola University Hospital in Maywood, IL. I asked her if there was some way to verify if it was shingles, and she suggested my mother have a blood test done to test for the presence of the chicken pox virus. I don't remember the name, except that it starts with a v. Also, I was under the impression that a person can't get shingles from shingles. I wonder if that's always true. Something weird is going on with my mom and me.

[Dr. Anthony Solomon]

There are contradictions in your first and subsequent posts. The first post emphasises the absence of a rash, which prompted you to ask of a condition termed sans zoster.

In your subsequent post, there are indications of the presence of a rash when you stated "Dr O'Donahue and an associate looked at my rash and neither could decide if it was actually shingles or not". There are further inferences of a rash "the rash and blisters I currently exhibit look like shingles" … but this was further contradicted again by "….she has all the symptoms of shingles without the actual rash or ensuing blisters".

What is the correct status - is a rash present or not, and is it on a dermatome on the trunk? Is there any associated pain?

In almost all cases, herpes zoster can be confidently diagnosed by history and the appearance and distribution of the rash. When the diagnosis is in doubt, and confirmation is desired, the Varicella-Zoster Antibodies IgM test can be done. A positive IgM test is indicative of current or recent infection with the virus that causes shingles (and chicken pox).

Shingles is linked to old age, high stress situations, or situations in which the immune system is impaired. Often, only one attack occurs without recurrence. If an adult or child has not had chickenpox or has not received the chickenpox vaccine, and is in contact with a shingles case, chicken pox may develop rather than shingles.


Dr Anthony Solomon
Consultant Physician, Tropical & Genitourinary Medicine

[question]

Sorry about the confusion Doctor. In my initial inquiry to you I was speaking of my mother who has all the symptoms except the rash & blisters. Her discomfort is about half way down, on the left side of her back, from her spine over towards her side. That whole middle to lower quarter of her back seemed to have been affected. I don't know if that's considered a dermatome. And , yes, there was considerable pain, rather like a burning sensation, itching, & the feeling that something was running up her back. However, as 7 weeks has elapsed since the onset, my mother's pain is subsiding. However, the itching remains intense.

When I replied to your question regarding where I had heard the term sans zoster, I tried to explain that in addition to my mother's symptoms, I recently came down with a rash which might be shingles and so consulted Dr. O'Donahue. It was at that consultation regarding my rash that I also queried Dr. O'Donahue about my mother's symptoms. It was at that time that she mentioned the term sans zoster relative to my mother's condition.

I hope this clears up any confusion on your part. Thank you for your time and input.

[kl]

I have been ill since August with burning in hands and feet, electric shock like pain throughout my body, Intense stiff neck and arm pain, confusion, numbness in face and intermittantly throughout body. I have had mri and so many tests I can't list them all. I have had an unspecified herpes rash for years that appears on my neck and sometimes on arms and back. Very tiny little blisters that never appear on face or genitals. When I became ill this August it was so intense that I was actually having difficultiy thinking and my gait became lopsided. I could barely go up stairs. I took some Valtrex even though i had no rash and the symptoms subsided enough for me to work. I quit taking the Valtrex for 2 days and all the symptoms came right back in a day. Now I have a rash on the back of my neck also. I started the Valtrex again and I'm better. Do I rush over to the lab to get the rash tested while it is new? I can't believe how intense this illness is. I am miserable. Its never been this intense or lasted so long in the past. I am very worried. I do not have HIV - was tested - but worry that I may be immune suppressed to have such a bad episode. It is not over yet either.

Help - any info will be much appreciated.

KL

[sheeddy]

I suffer from zosters and have for the last 17 years I break out about 2 a yr sometimes more depending on my stress level or if I come down with something my body has to work hard to fight. I do all the time get symptoms with out the rash. My whole left side will hurt and my skin will burn I can even touch my skin and follow the path of the nerve from the pain, down my body and often times this will occure without a rash, but I have had the condition for many yrs in the begining I always had a rash or sores. Also I have never heard of sans zosters in all the years Iv been treated for the condition.