Zoster sine herpete (ZSH) is a form of shingles without any rash: there is only pain or nerve sensations without the typical skin rash or blisters. It is caused by the same virus as regular shingles, varicella-zoster virus (VZV). Shingles usually diagnosed by looking at the rash. So ZSH can be difficult to diagnose because of the absence of any symptoms on the skin..
Nearly everyone gets chickenpox as a child. Shingles (herpes zoster) is a reappearance of the chickenpox virus, many years later. So nearly everyone can develop shingles. It is a common condition. It happens most frequently in older people.
How common is zoster sine herpete?
A survey in the USA in 2009 by B.A. Weaver, found that ZSH (shingles without skin symptoms) occurred in one in 200 people. It is probable that ZSH is more common than this, but many cases will not have been diagnosed and recorded. In particular, people are unlikely to go to the doctor when they have a milder case, which clears up by itself in a week or two.
What are the symptoms of zoster sine herpete
Symptoms of ZSH are similar to those of regular shingles but without the rash. These will be on one side of the body and in one area of the body. They can include tingling, pain, burning, itching, numbness. These symptoms can be misdiagnosed as being from an insect bite, a pulled muscle or similar everyday occurrence. There may be flu-like symptoms such as headache and fatigue.
A doctor could order laboratory tests to check antibody levels to diagnose ZSH but will most often just prescribe antiviral tablets without any tests. Testing is more likely to be done when the pain is on the face or head in order to rule out other conditions.
If ZSH is diagnosed early enough, then the usual shingles treatment will help minimise pain and help prevent PHN.
This post composed 16-5-2025