When talking about shingles (herpes zoster), the first thing that comes to our mind is the characteristic rash that typically spreads in a belt like pattern, usually over the abdomen, chest, and the neck area. However, there have been instances in which people have been diagnosed with shingles without rash. This condition is referred to as zoster sine herpete, meaning absence of rash despite the affected person showing all other symptoms of shingles. Symptoms As we all know, shingles is nothing but an infection of varicella zoster virus affecting the nerve roots and is generally diagnosed in people over 60 years of age. A person who contracts this virus does not develop any rash for the first few days, although this period of absence of rash can last up to 3 weeks. The typical symptoms of shingles in women and men in the initial days are headache, fever and this is followed by painful burning sensation on a specific area of the skin. Besides feeling feverish, the person may experience chills and nausea. After the initial days of infection, the person shows a shingles rash forming a band like pattern, usually on the torso. The fluid-filled blisters eventually turn crusty lesions in a week's time. In shingles but with no sign of rash, the chronic pain affects the same section of the body, where rash is generally seen but in this case rash does not appear. The pain associated with zoster sine herpete, can be intense and is not just confined to the superficial skin. So, apart from tingling sensation on the skin, the person may experience throbbing pain involving the muscles. Although the burning sensation associated with zoster sine herpete is restricted to the torso, in some cases the facial area is affected. This condition is referred to as Bell's Palsy in which the viral infection strikes the facial nerve. As a result, the person may lose control over facial muscles, eventually causing Bell's Palsy (paralysis of facial muscles). Bell's Palsy usually does not involve the whole face; only one side of facial area is affected and marked by inability to smile or close the eyes properly. Treatment Usually, this infection without rash affects people who are quite old (more than 75 years of age). As the characteristic rash is not visible in zoster sine herpete, diagnosing this condition is not easy. There is a high probability of misdiagnosis in case of zoster sine herpete. The severe chest discomfort that sometimes accompanies this infection can be misinterpreted as a heart attack or a respiratory problem. So, a confirmatory test for diagnosis involves taking the patient's blood sample and observing it under the microscope to determine the presence of varicella zoster virus. Once the blood test confirms the existence of virus, the patient is put on a dose of antiviral drugs for a specific duration. To reduce pain associated with this viral infection, taking narcotics (numbing agent) like oxycodone may also be prescribed. Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.