Having shingles is a painful and unpleasant experience. It can be challenging to know what you should do if you have just found out that you, or someone in your family, has been diagnosed with this condition. Additionally, there are also several complications associated with the disease that may severely affect one’s quality of life.
In this article, we will be discussing a lesser-known form of shingles known as internal shingles. Read on to find out more about the symptoms of internal shingles and some treatment options here!
First of all, what is internal shingles? We can describe it as a more severe version of the regular shingles. Typically shingles, which is also known as herpes zoster, is a disease caused by the same virus that causes chickenpox. This virus is known as the varicella-zoster virus. Shingles occurs when one has already had chickenpox before. The virus continues to lay dormant in the system and may reactivate later in life, causing shingles. While shingles typically affects the skin (namely, the skin along the nerve path where the virus had been dormant), the organs might be affected instead if the reactivation of the virus is severe enough. As there are no rashes on the skin, the shingles is not presented externally. Therefore, this is known as internal shingles or systemic shingles. The medical term for this is known as Zoster sine herpete.
The symptoms of internal shingles are listed below. While this list is not extensive, it lists some of the more common symptoms for people with internal shingles.
Symptoms:
- chills
- pain
- muscle aches
- numbness and tingling
- burning sensation in the skin
- swollen lymph nodes
- fever
- headache
Depending on the symptoms alone, diagnosing internal shingles is very difficult and may result in a misdiagnosis. With the lack of skin rashes to indicate shingles, your doctor may need to take an extensive look into your medical history for possible indications of internal shingles, especially in patients with a history of radicular pain, peripheral facial palsy, or muscle paralysis without a rash (Zhou et al., 2020). The key ways that your doctor can identify internal shingles is via laboratory testing such as polymerase chain reaction (which identifies viral DNA) and viral antibody tests. If left undetected and untreated, continuous activation of the virus may damage the nerve cells, causing postherpetic neuralgia (PHN), a chronic condition of pain that can last for months or even years after shingles has been resolved. It is also said that the chances of developing postherpetic neuralgia is higher in patients with internal shingles as compared to patients with typical shingles.
Internal shingles can be a severe condition as it may affect the different organs of one’s body depending on the position of the affected nerve cells in the body. The most commonly affected organ is, without any doubt, the digestive system. Internal shingles affecting this part of your body will usually present with symptoms similar to regular gastroenteritis or what we know as stomach flu. Patients affected with this type of internal shingles experience chronic, unexplained abdominal pain as gastric ulcers form in their digestive tract (Gershon & Gershon, 2018).
Besides the digestive system, internal shingles can also affect the respiratory system, heart, and blood vessels. About 20-40% of patients experience some form of cerebrovascular event, while 10-30% of patients with internal shingles experience some form of cardiac disease (Erskine et al., 2017).
As there are no treatments specifically for internal shingles, treatment is mostly the same as with regular shingles. Treatment for internal shingles usually consists of both antiviral drugs (such as acyclovir and valacyclovir) to shorten and lessen symptoms of a shingles outbreak, along with prescription painkillers (such as non-steroidal anti-inflammatory drugs, tramadol and opioids), tricyclic antidepressants and/or corticosteroids to manage the severity of symptoms. It is essential to begin treatment as soon as possible to reduce viral activity and, consequently, the chances of neuropathological damage. Therefore one should seek medical attention as quickly as possible for an accurate diagnosis and timely treatment.
In conclusion, internal shingles is a very rare occurrence of shingles that affects the nerve cells inside the body rather than on the skin. Due to its generic symptoms, which are seen in many other diseases, and the lack of skin rashes to indicate shingles, internal shingles can be a challenging condition to diagnose and treat. Doctors often rely on a review of a patient’s medical history and lab tests to determine the presence of internal shingles. As with regular shingles, treatment usually consists of antiviral medications and prescription painkillers (such as non-steroidal anti-inflammatory drugs, tramadol, and opioids), tricyclic antidepressants, and corticosteroids. While there is no specific treatment for internal shingles, such treatment can help to reduce its severity and prevent potential damage caused by neuropathological manifestations. Prompt treatment is necessary to avoid complications and to ensure a faster recovery.
Erskine, N., Tran, H., Levin, L., Ulbricht, C., Fingeroth, J., Kiefe, C., Goldberg, R. J., & Singh, S. (2017). A systematic review and meta-analysis on Herpes Zoster and the risk of cardiac and cerebrovascular events. PLOS ONE, 12(7)
Gershon, M., & Gershon, A. (2018). Varicella-zoster virus and the enteric nervous system. The Journal of Infectious Diseases, 218(suppl_2)
Zhou, J., Li, J., Ma, L., & Cao, S. (2020). Zoster Sine Herpete: A Review. The Korean Journal of Pain, 33(3), 208–215