We have tackled in this website about Shingles, now, we will focus on Internal Shingles. But, first, let’s recap about Shingles and then, we will proceed about the main topic.
Introduction to Shingles
Shingles is a viral infection that causes a very painful skin rash or blisters on an area of the skin. This viral disease is very common in adults especially those who have weak immune systems because of having stress, injury and taking various medications. This skin disease is caused by Varicella-zoster virus or what we call the zoster virus, the same virus which is also the main cause of chickenpox. Usually, when a child heals from chickenpox, when he or she reaches adulthood, the virus might still remain in his or her body and lies inactive, and then, it will become active again and here comes the Shingles.
Can Shingles be internal and have no rash?
Yes, and this will be called as Internal shingles. It may also involve rashes inside the mouth or ear. Eyes, brain, muscle and nerve problems are the main organs involved in this.
This attacks the nerves in the body and may also not involve rashes and blisters. It is very rare. The very common symptoms are flu-like symptoms (flu that often occurs without fever), pain and movement problems. Other symptoms are sensitivity to light, diarrhea, headaches and stomach aches. Some of the symptoms of internal shingles can be very dangerous and can cause severe complications to the body. This disease is not life-threatening as long as you have performed an early diagnosis that is measured at the right time. You can control this easily and will prevent further spread of the infection.
Diagnosis, Signs and Symptoms
- Flu-like symptoms but no fever
- Sensitivity to light
- Stomach aches
- Movement problems
- Burning or tickling sensations where the rashes will appear
The prevalent ones:
- Oral pain where blisters or lesions are inside your mouth and the pain will affect your eating.
- Lymph node swelling happens when your body’s immune system is resisting the virus. It is found in the groin area, underneath the arms or side of the neck.
- Encephalitis – occurs because Shingles attacks the nerves of (also others that are connected) the brain which will result into swelling and inflammation of the brain. If you are experiencing this symptom, visit a doctor immediately because this might lead into a life threatening condition.
Tests to identify the Shingles virus
If the symptoms are not obvious in some patients especially the immunosuppressed ones, to detect Shingles, physicians will perform one or more tests. Also, the tests will usually aim to distinguish herpes simplex virus and varicella-zoster virus.
The tests that they do are: Immunofluorescence Assay, Polymerase Chain Reaction (PCR) and Virus Culture.
Immunofluorescence Assay is performed by using UV rays applied to cells taken from the zoster blisters. Presence of antibodies can be identified depending on the specific characteristics of light seen through a microscope. It is thought to be cheaper, faster and more accurate than performing a virus culture.
Virus Culture – taking specimens from the blisters, spinal fluid or fluid inside the blisters. For vaccinated patients, this is useful to determine if the internal shingles infection was caused by a natural virus or by the vaccine that they had taken before.
Polymerase Chain Reaction (PCR) is performed to identify the infection in the central nervous system (brain and nerves). It replicates a piece of the DNA of the virus up to millions of times until the virus can be detected.
Internal Shingles Complications
|Postherpetic neuralgia||Burning and throbbing nerve pain, symptoms include extreme sensitivity to light touch and temperature change, numbness, itching, headaches and sudden or occasional pain. Worse, the affected person might experience muscle weakness or become paralyzed due to uncontrolled muscle movements.
|Ramsay Hunt Syndrome||Facial nerve paralysis (facial palsy) and having a rash on mouth or the ear.
Also, it may be accompanied by other frequent signs and symptoms such as hearing loss, facial weakness or face drop, nausea, tinnitus, nystagmus (oscillation of the eyes) and vertigo (type of dizziness).
|Hutchinson’s Sign||Vesicles on the tip of the nose, or vesicles on the side of the nose are involved from facial herpes zoster - ophthalmic herpes zoster
Skin - Melanonychia, Periungual hyperpigmentation.
|Neurological problems||Balance problems, hearing problems, facial paralysis or inflammation. These conditions can be very dangerous and can result to coma or death.
|Loss of Vision (Ocular or Optical Shingles)||Lack of sensation in the eye, pain, redness, swollen eyelids, blurry vision, discharge from the eyes, and temporary or permanent blindness.
|Other internal organs||Blisters to affect internal organs including lungs, gastrointestinal tract, central nervous system and the brain. Pneumonia and other breathing problems can occur if the lungs become affected.
Postherpetic neuralgia is a persistent nerve pain that occurs to some patients within 2-4 weeks after healing from Shingles or often referred to as post-shingles pain.
If you are still experiencing pain after your shingles rashes are cleared up, you might have caught this.
After healing from Shingles, the zoster virus still remains in the patient’s body. It invades the bloodstream and damages the nerve fibers thus, become confused resulting in sending uncontrolled and inaccurate signals to the brain which causes burning and throbbing nerve pain.
As of the present, nobody knows why some patients are experiencing this and why some are not.
Aside from the mentioned burning and throbbing nerve pain, symptoms include extreme sensitivity to light touch and temperature change, numbness, itching, headaches and sudden or occasional pain. Worse, the affected person might experience muscle weakness or become paralyzed due to uncontrolled muscle movements.
Patients will experience sleeping problems and fatigue. Postherpetic neuralgia lasts in one month or if severe, may last up to one year.
Image from Flickr
Ramsay Hunt Syndrome
Also caused by varicella zoster virus, RHS is known as auricular herpes zoster or herpes zoster oticus when referring only to the ear rash. It is a rare neurological disorder and can be characterized by facial nerve paralysis (facial palsy) and having a rash on mouth or the ear. Same with postherpetic neuralgia, Ramsay Hunt Syndrome occurs when the previously zoster virus becomes active again and spreads to the facial nerve.
There is often pain in the ear. Also, it may be accompanied by other frequent signs and symptoms such as hearing loss, facial weakness or face drop, nausea, tinnitus, nystagmus (oscillation of the eyes) and vertigo (type of dizziness).
Sometimes, people find it difficult to distinguish Ramsay Hunt Syndrome from Bell’s palsy in early stages but in general, RHS tends to be more serious and severe than Bell’s palsy. Also, RHS has rashes/blisters while Bell’s palsy don’t. Not all cases of RHS has rashes but it can be still RHS as long as it was caused by zoster virus.
Ramsay Hunt Syndrome Diagnosis
To tell easier and accurately if you really have a Ramsay Hunt Syndrome, your physician will.do one or more of the flowing:
- The doctor will observe you especially your face and ear to know if the symptoms are present.
- Tested through tuning forks or audiometry (wearing earphones in usually a soundproof booth / room)
Otoscope Ear Examination
- Your doctor will check your auricle (visible part) and ear canal for lesions (that might indicate the varicella-zoster virus’ presence) using an otoscope.
Horizontal Gaze Nystagmus (HGN) test
- It involves caloric testing and tracking a moving object or field to be able to determine the degree of vestibular impairment.
Fluorescein Eye Strain
- Used to detect cornea damage and the outer surface of the eye by using orange dye (fluorescin) and a blue light.
- A nerve conduction test using contact pads or fine-scale conductive probes to determine facial nerve damage and its potential for recovery.
- When diagnosis is not clear, in rare cases, a spinal tap is used. After numbing with an anesthetic, from the spinal column, a cerebral fluid is taken by using a spinal needle to test it for evidence of zoster virus.
Blood test, MRI, CT (Computed Tomography) Scan, and Eye test (checking dryness and change of vision).
If for vesicles on the tip of the nose, or vesicles on the side of the nose are involved from facial herpes zoster, it precedes the development of ophthalmic herpes zoster thus, implies the involvement of the nasal branch of the nasociliary nerve that raises the specter of involvement of the eye.
If for the skin, it involves the pigmentation of the proximal nail fold which is also known Melanonychia. It also suggests subungual melanoma when there is pigmentation in the paronychial area or known as Periungual hyperpigmentation.
Balance problems, hearing problems, facial paralysis or inflammation might be experienced after suffering from a shingles outbreak and may permanently damage the nerves.
These conditions can be very dangerous and can result to coma or death. No worries, these are rare but being prepared will be better.
Loss of Vision
Optical shingles or Ocular shingles is crucial and includes any of these symptoms such as lack of sensation in the eye, pain, redness, swollen eyelids, blurry vision, discharge from the eyes, and temporary or permanent blindness.
Additional symptoms and signs are: severe ocular pain, tingling of forehead, conjunctival episcleral and circumcorneal conjunctival hyperemia, corneal edema, marked eyelid ederma and photophobia.
Its complications include cataract, glaucoma, keratitis (inflammation of the cornea), uveitis (inflammation of uvea/middle layer of the eye) and other corneal problems.
If you are experiencing these (even the minor ones), do not self-medicate and you must seek a doctor’s help immediately.
Other internal organs
It is possible for the virus especially the blisters to affect internal organs including lungs, gastrointestinal tract, central nervous system and the brain. Pneumonia and other breathing problems can occur if the lungs become affected.
Internal Shingles Treatment
Drugs, treatments, home remedies and vaccines
For you not to be surprised, the frequently advised drugs by the doctors are opioid painkillers, anticonvulsants, capsaicin skin patches, lidocaine skin patches, antidepressants and steroids. For treatments, these are TENS (transcutaneous electrical nerve stimulation), and Spinal cord or peripheral nerve stimulation.
Aside from capsaicin skin patches, you can avail, capsaicin cream.
If you are in your home and are not planning to buy prescribed medications yet, go for topical analgesics and anesthetics to reduce skin oversensitivity by mixing aspirin into an absorbing cream or lidocaine cream.
Antiviral drugs like Acyclovir, Famciclovir or Valacyclovir can be taken to restrict the virus from replicating. Normally, it will take 2-5 weeks for internal shingles’ symptoms to be fully resolved. The ones who might show severe symptoms of it are the elders and children.
Ice pack or heat treatment application is temporarily effective in reducing pain. Doing this can help the patients to reduce their urge to scratch their skin.
Internal Shingles pain relief
The pain of shingles especially the internal one is unbearable in its severity. All patients with shingles are given medications that can minimize pain. The pain of herpes zoster affects not only your sleep, mood or work, but also, your quality of life. This often leads to fatigue, loss of appetite and feeling of depression. If you have:
Medicines for Internal Shingles pain
|Internal Shingles pain severity||Medicines
|Mild pain||Opioids such as Morphine, Tramadol and Fentanyl.
|Severe pain||Darvon, Codeine, or one of the Codeine derivatives such as Vicodin or Percodan.
In order to control shingles pain further, you should take advice from an experienced doctor in homeopathy so he or she can examine your pain and then will prescribe a treatment for it.
Is it contagious?
Some people think that shingles is caused by a virus and viruses are contagious but, it is not a contagious disease though it is caused by the same virus which is responsible for Chickenpox. We can say, Shingles is a second outbreak of the chickenpox virus in the body but it cannot cause other forms of herpes. However, shingles contains infectious VZV and people who have not had chickenpox before can develop easily this virus from daily interaction to patients with Shingles. Shingles can only be spread by direct contact to lesions of the patients. Otherwise, you have minimum chance to develop an infection. For the patients, they can still go outside and perform normal activities like daily work or going to school as long as they prevent spreading the disease by good hygiene and covering their lesions properly.
Shingles in general
Who gets it?
Generally, it is happened in adults especially from ages 50-60 but it does not mean that young people would not be affected.
Aside from aging and weak immune system, medications, stress, various treatments particularly cancer and, if their mothers have shingles during their late pregnancy or had a chickenpox themselves (affected adults) during childhood can also be causes of Shingles. The main cause for this awful and alarming disease is the Vacirella-zoster virus. This virus belongs to a group of viruses called herpesviruses and it hides in the nervous system after the occurrence of initial infection and travels down to the nerve cell fibers to cause a renewed infection.
Difference between Herpes Simplex and Herpes Zoster
Both of these are herpes viruses but different in class and type.
Herpes Zoster or Varicella Zoster-Virus, causes skin rashes or blisters, and is the main culprit for chickenpox and shingles, while Herpes Simplex causes small painful fluid-filled blisters on the eyes, mouth (cold sores), lips and genitals.
Is Herpes Simplex contagious?
HS is more contagious than HZ since anyone has a higher chance of getting the disease just by having direct contact with sores or even on affected areas without sores. Also, Herpes Simplex’s tests such as biopsy of a sore, blood tests, etc. must be conducted to recognize the sores.
Medications for Shingles
Since you have learned above about medicines to treat internal shingles, just take these and the treatments below that can treat shingles blisters, rashes or shingles in general.
To relieve itching and keeping your skin hydrated, unscented lotions especially calamine lotion, moisturizing creams, honey or petroleum jelly are perfect. Using scented moisturizers are not recommended because these may cause irritation and allergies.
For those who want to get a vaccination, Zostavax is recommended.
Home or Natural Remedies
For the blisters to dry faster, Domeboro solution or a cornstarch paste can be applied. Ready-made oatmeal bath mixes can be bought at drugstores or pharmacies to soak your skin and have a clean, soothing, relaxing and calming experience.
Licorice and other plan extracts can soothe skin inflammation while lemon balm counters herpes viruses and aids in healing rashes or cold sores.
Eating, drinking or applying vitamin E supplements is good for healing skin problems and nerve damages. B-complex can strengthen the nervous system which can also reduce nerve pain. Vitamins A and D increase the production of macrophages and killer T-cells, and can fortify the affected person’s immunity system.
Eating a spoonful of flaxseed powder 2x a day, garlic juices or turmeric paste can speed up the healing process because of having antiseptic properties.
To sum these up, we may say that internal shingles can become dangerous, contagious and later on, become deadly if not treated. It must be given more attention so doctors can diagnose the symptoms and can give the patient proper medicines and treatments immediately. Shingles, internal or external, has been caused by the virus Varicella-Zoster virus, also known as, Herpes Zoster. Shingles can happen to people especially to those who already healed from chickenpox but have weak immune systems. It can occur due to the reactivation of this virus inside the body. Generally, it can cause skin rash or blisters. In some cases, it can cause a severe systemic infection, affecting internal organs of the body and the central nervous system. Doctors often prescribe antiviral medications such as Acyclovir (Zovirax®), Valacyclovir (Valtrex®), and Famciclovir (Famvir®) for its treatment. In most cases, it has been advised that antiviral drugs should be taken within 3 days or 72 hours from the time of the first sign of shingles. To endure pain, doctors may suggest antidepressants. Healthy diet or breathing exercises at home, taking regular meditation, yoga, or tai chi classes will help patients to deal with it. Having a strong immune system and avoiding processed and artificial foods as possible are the simplest methods to prevent having this.