Shingles is a viral nerve infection that causes a painful rash and blistering. In some cases, the infection can spread to internal organs and appear without a rash, which doctors call internal shingles.

Shingles, or herpes zoster, usually clears up in 2–4 weeks. However, as the infection can spread to other organs, it may lead to serious and potentially life threatening complications if left untreated.

This article looks at the causes, symptoms, and complications of internal shingles, as well as treatment and prevention.

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Shingles usually cause a painful, itchy, blistering rash. Shingles with no rash is zoster sine herpete (ZSH) and may cause the following symptoms:

The pain from shingles can vary from mild to severe. People may experience sharp, stabbing pains, and the affected skin may feel tender.

In rare cases, the shingles virus can spread to the internal organs and cause inflammation. Internal shingles can cause the following complications, depending on the organ it affects:

These conditions are all very serious and potentially life threatening if left untreated. Neurological symptoms that occur outside the rash area require immediate medical attention.

This rash and any itchiness or burning usually occur in a single band or stripe on one side of the body. It usually occurs around the waist, chest, stomach, or back.

However, shingles can occur on almost any part of the body, including the face, and can spread to more than one area.

Learn more about shingles.

The varicella-zoster virus causes shingles, which is the same virus responsible for chickenpox. Anyone who has had chickenpox can develop shingles later in life. Researchers are not sure why shingles may sometimes appear without a rash.

More than 99% of Americans ages 40 years and older have had chickenpox — usually during childhood.

Following chickenpox, the virus settles in the nervous system near the spinal cord or the base of the skull. There, it remains for the rest of a person’s life and is usually kept in check by the immune system.

However, the virus can reactivate at any time. When this occurs, it multiplies and travels along the nerve fibers on one side of the body to the skin, causing symptoms of shingles.

Many internal symptoms may occur before the rash. In rare cases of ZSH, a rash will never appear.

Doctors do not fully understand why the virus reactivates in some people but not others. However, a weakened immune system is thought to be a contributing factor. This may result from:

  • advanced age
  • physical and emotional stress
  • conditions that compromise the immune system, such as HIV and AIDS
  • medications or treatments that suppress the immune system, such as those used in chemotherapy or organ transplantation

People of any age can get shingles, including young children. However, the risk increases significantly with age, and it mostly occurs in people over 50 years.

A doctor can usually diagnose shingles based on a history of the symptoms and an examination of the rash. In some cases, a skin sample or fluid sample from a blister may be necessary.

Shingles without a rash is more difficult to diagnose, and doctors need to do extra tests.

There is no cure for shingles, but antiviral medications can reduce the severity and decrease the risk of developing complications. Antiviral medications are necessary within 72 hours of the rash appearing.

Painkillers available for purchase over the counter or online, such as acetaminophen and ibuprofen, can relieve the pain, but a doctor can prescribe stronger painkillers if necessary.

People with shingles should keep the rash covered, wear loose-fitting clothes, and avoid scratching or picking the blisters. Applying a cool, damp washcloth may help the blisters dry out faster and ease the pain.

People with shingles can ease their discomfort by:

  • getting plenty of rest
  • trying gentle stretches or walking
  • distracting themselves by reading, watching TV, listening to music, or playing games
  • avoiding stress
  • using calamine lotion or an oatmeal bath to soothe the skin

People cannot catch shingles from another person, but they can catch chickenpox from a person with shingles. This can only happen if the person has not had chickenpox or received the vaccine.

The varicella-zoster virus, which is present in shingles blisters, can spread if someone comes into direct contact with the fluid. It remains contagious until the last blister has dried up and scabbed over.

The risk of spreading the virus is low if a person keeps the rash covered. Individuals with shingles should avoid contact with anyone who has not already had chickenpox. This is particularly important with the following groups of individuals:

  • pregnant people
  • babies less than 1 month old
  • people living with HIV or AIDS
  • people undergoing chemotherapy
  • people having bone marrow or organ transplants

People with shingles should also wash their hands often and avoid swimming, playing contact sports, and sharing towels. If the rash is oozing and someone cannot cover it, they should stay home from work or school.

Complications from shingles are more likely to occur in older adults or people with weakened immune systems. The following are possible shingles complications:

Postherpetic neuralgia

Following shingles, some people experience nerve pain and intense itching in the area where the rash was. This is postherpetic neuralgia (PHN). It is the most common complication of shingles and develops in around 10–13% of people who have had shingles.

PHN can persist for months or even years after the other symptoms of shingles have cleared. PHN can be severe, and the pain can be constant or intermittent. In some people, very light touch or changes in temperature can trigger the pain.

PHN can interfere with daily life and can cause depression, anxiety, insomnia, and unintended weight loss.

Ophthalmic shingles

If shingles develop on the face, there is a risk of the eyes being affected. Potential complications involving the eye include:

  • inflammation, causing redness and discharge
  • permanent scarring of the cornea
  • glaucoma or pressure in the eye
  • vision problems

If blisters occur in or around the eyes, prompt treatment is necessary to avoid the risk of vision loss.

Ramsay Hunt syndrome

Shingles infections near or within the ear can cause Ramsay Hunt syndrome, which leads to hearing or balance problems, dizziness, earache, and paralysis of the face.

Roughly 70% of individuals with Ramsay Hunt syndrome will make a full recovery if they receive antiviral medication within 72 hours of the onset of their symptoms. However, some people may have long-term hearing loss or facial paralysis.

Here are some frequently asked questions about shingles without a rash.

What are the symptoms of shingles without a rash?

Symptoms of shingles without a rash include chills, pain, swollen lymph nodes, and fever.

What are the symptoms of early shingles?

Symptoms of early shingles usually include discolored rashes and blisters on the body.

Shingles usually causes a painful rash and blistering, but in some cases, the infection can appear without a rash, which doctors call internal shingles. The infection can spread to the organs, possibly resulting in life threatening complications.

Internal shingles without a rash usually results in symptoms such as fever, chills, headache, and swollen lymph nodes.

There is no cure for shingles, but taking antiviral medications within 72 hours can decrease the severity and shorten the duration of symptoms.