Summary about Disease
Zoster sine herpete (ZSH) is a variant of herpes zoster (shingles) characterized by the pain and other neurological symptoms associated with shingles, but without the characteristic rash. It is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox and shingles. Because of the absence of a rash, diagnosis can be challenging.
Symptoms
The primary symptom is pain in a dermatomal distribution (an area of skin supplied by a single spinal nerve). Other symptoms may include:
Itching
Burning sensation
Tingling or numbness
Headache
Fever
Malaise (general feeling of discomfort)
Sensitivity to touch
Causes
ZSH is caused by the reactivation of the varicella-zoster virus (VZV) that has been dormant in the sensory nerve ganglia since a prior chickenpox infection. The exact reason for reactivation is not always clear, but factors that may contribute include:
Weakened immune system (due to age, illness, or medication)
Stress
Physical trauma
Certain medical conditions
Medicine Used
The same antiviral medications used to treat shingles are typically used for ZSH:
Acyclovir
Valacyclovir
Famciclovir Pain management may include:
Over-the-counter pain relievers (acetaminophen, ibuprofen)
Prescription pain medications (opioids, gabapentin, pregabalin)
Topical creams or patches (lidocaine)
Is Communicable
ZSH itself is not directly communicable. However, a person with ZSH can potentially transmit the varicella-zoster virus to someone who has never had chickenpox or the chickenpox vaccine. In this case, the person would develop chickenpox, not ZSH. The risk of transmission is low due to the absence of blisters and open sores.
Precautions
Although not as contagious as shingles with a rash, it is still prudent to take precautions:
Avoid close contact with pregnant women who have never had chickenpox or the vaccine, newborns, and people with weakened immune systems.
Wash hands frequently.
Cover any areas of skin where symptoms are present.
How long does an outbreak last?
The duration of a ZSH outbreak can vary. If treated promptly with antiviral medications, symptoms may resolve within 2-6 weeks. However, some individuals may experience postherpetic neuralgia (PHN), which is chronic nerve pain that can last for months or even years after the initial outbreak.
How is it diagnosed?
Diagnosis of ZSH is challenging due to the absence of a rash. Diagnosis relies on:
Patient history (including prior chickenpox infection)
Description of symptoms (particularly dermatomal pain)
Ruling out other conditions
Laboratory tests (PCR to detect VZV DNA in cerebrospinal fluid or skin biopsy if there's any subtle skin change to sample; VZV antibody testing can also be considered, though less helpful).
Timeline of Symptoms
The timeline can vary significantly:
Prodromal Phase: This may precede the pain by several days, and can include headache, fever, malaise.
Pain Phase: Pain, itching, tingling, or numbness develop in a dermatomal distribution.
Resolution Phase: Symptoms gradually subside, usually within 2-6 weeks with antiviral treatment.
Postherpetic Neuralgia (PHN): In some cases, chronic pain (PHN) develops and can persist for months or years.
Important Considerations
Early diagnosis and treatment with antiviral medications are crucial to reduce the severity and duration of symptoms and to prevent complications such as PHN.
Because of the lack of a rash, ZSH is often misdiagnosed, leading to delayed treatment.
If you experience unexplained pain or neurological symptoms, especially if you have a history of chickenpox, consult a healthcare professional.
Pain management is an important aspect of treatment, particularly if PHN develops.