The two most characteristic symptoms of shingles are pain following a nerve along one side of the body and a rash that follows the path of that nerve. However, some people develop shingles without a rash; this is a condition known as zoster sine herpeticum (or herpete). Others may develop a rash that is overlooked because it is so small; this is a condition known as zoster cum herpete minimo.
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Zoster sine herpete is an exceptionally rare condition, although, as noted in "Infections of the Nervous System," the difficulty of diagnosing shingles without a rash means that it is unknown precisely how often it occurs.
Cum Herpete Minimo
Some cases of zoster sine herpete may actually be zoster cum herpete minimo, as noted by R.A. Murray Scott in the British Medical Journal. In this condition, the shingles rash is minimal and may be overlooked by both patient and doctor.
People who do develop shingles with no rash still experience the characteristic pain on one side of their body that follows the path of the nerve in which the varicella-zoster virus (VZV) has been reactivated.
Diagnosis of shingles is complicated when no rash is present. Scheld, et al., note that diagnosis can be made through testing for antibodies to VZV as well as for VZV DNA via polymerase chain reaction testing.
When it is confirmed that people thought to have zoster sine herpete are experiencing a shingles outbreak, standard treatment for shingles is administered. These include a course of antiviral drugs (acyclovir, valacyclovir or famciclovir) and corticosteroids to manage nerve damage, along with methodologies to relieve pain.