Shingles without a rash is called “zoster sine herpete” (ZSH). It’s not common. It’s also difficult to diagnose because the usual shingles rash isn’t present.

The chickenpox virus causes all forms of shingles. This virus is known as varicella zoster virus (VZV). If you’ve had chickenpox, the virus will remain dormant in your nerve cells. Experts don’t fully understand what causes the virus to reactivate and why it only reactivates in some people.

When VZV reappears as shingles, the virus is known as herpes zoster. Keep reading to learn more about this condition and what to expect if you develop shingles without a rash.

The symptoms of ZSH are similar to the symptoms of shingles, but without a rash. The symptoms are usually isolated to one side of the body and commonly occur on the face and neck, and in the eyes. Symptoms can also occur in the internal organs. Typical symptoms include:

No one fully understands why VZV reactivates as shingles in some people.

Shingles often occurs in people with compromised immune systems. Your immune system may become compromised because of:

Shingles isn’t contagious. You can’t give someone else shingles. If you have shingles and are in contact with someone who hasn’t had chickenpox or wasn’t vaccinated for chickenpox, you can give that person chickenpox. That person would have to come in direct contact with your shingles rash.

If you have shingles without a rash, you shouldn’t be able to pass it to others. Still, it’s a good idea to avoid contact with people who haven’t had chickenpox as well as pregnant women until your other symptoms have cleared up.

You can only get shingles if you’ve had chickenpox in the past. You’re at an increased risk for shingles if you:

  • are over age 50
  • have a weakened immune system
  • are under stress from surgery or trauma

Shingles without a rash isn’t common, but it may be more common than previously thought because it often goes undiagnosed. Shingles without a rash is difficult to diagnose based on your symptoms alone.

Your doctor may test your blood, cerebrospinal fluid, or saliva to identify the presence of VZV antibodies. This will allow them to confirm a diagnosis of shingles without a rash. However, these tests are often inconclusive.

Your medical history may provide clues that suggest you have shingles without a rash. Your doctor may ask if you’ve had a recent operation or if you’re under increased stress.

Once your doctor suspects you have VZV, they’ll use antiviral medicines such as acyclovir (Valtrex, Zovirax) to treat the shingles. They may also prescribe drugs for the pain.

Other treatment will vary based on the location and severity of symptoms.

Shingles with a rash usually clears up within two to six weeks. If you have shingles without a rash, your symptoms should clear up in a similar amount of time. In a few cases, the pain can remain after the shingles rash has healed. This is called postherpetic neuralgia (PHN).

One case study suggests that people who have shingles without a rash are more likely to develop PHN than people who have the rash. If you have a weakened immune system and shingles without a rash, you also may be more likely to have shingles again.

In general, people who get the shingles vaccine have less severe shingles and a lower chance of having PHN. The shingles vaccine is recommended for people 50 years and older.

If you suspect you have shingles, it’s important to go to the doctor as soon as possible. If you have shingles, your doctor can give you an antiviral medication that lessens the pain and duration of it.

If you’re over 50, get vaccinated. Zoster vaccine (Shingrix) can decrease your risk of shingles but not prevent it. It will also lessen the severity and duration of your symptoms. This vaccine is recommended for people over 50, except those with compromised immune systems.

It’s likely that diagnosis of shingles without a rash will become easier as more research is done on the condition. It’s also likely that as more people are vaccinated against shingles, the number of cases will decrease.