Dear Alice,

Can one have shingles without any visible manifestation on the skin? Is the extreme sensitivity/pain sufficient or could that be the first symptom with rash to follow? How about several days of pain on the skin/sensitivity to touch without the rash or any other manifestation?

Friend of Stricken

Dear Friend of Stricken,

There is, in fact, a condition called zoster sine herpete (i.e., zoster, the virus, without the herpes blisters), in which nerves are affected without the usual rash associated with shingles. In this case, the nerve involvement causes pain and extreme sensitivity, but the rash just never shows up.

Usually with shingles, once the pain sets in, it can last for up to three days before the rash appears. Sometimes this period of pain before breakout lasts longer — the severe pain associated with shingles can continue for weeks, even months, before there's a rash.

Also important to note is that the pain created by shingles can last for quite a while after the blisters and all other symptoms of the illness have cleared up. This is especially true for people over the age of 50, as well as for people whose immune systems are not operating at 100 percent. The length of time of post-lesion pain varies considerably, from a few weeks to over a year. If a person has had shingles within the previous year or so, and feels like s/he is going to get it again, it could be that s/he is experiencing this after-the-fact pain, called "post-herpetic neuralgia."

Perhaps you could suggest to your friend that s/he make an appointment with a health care provider. You could offer to accompany your friend, and/or suggest that s/he bring this Go Ask Alice! Q&A along to show the medical provider. S/he will take a history and perform a physical exam, make a diagnosis, and determine a treatment and/or pain management plan.

And yes, once again, all the symptoms you mention are possible.

For more information, you can check out these resources:

Facts About Shingles (Varicella-Zoster Virus), National Institute of Allergy and Infectious Diseases Fact Sheet

Shingles — American Academy of Family Physicians

Centers for Disease Control and Prevention/National Immunization Program: Shingles general FAQs

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