Can Shingles Affect More than One Dermatome? C2, C3, C6, T1, L1, V2

Throughout the human body there are nerve endings that spider out towards the skin’s surface. Medical professionals have mapped out which areas of skin are attached to each specific spinal nerve, called dermatomes. The nerves provide sensory information to the spinal cord and brain, essentially allowing us to experience the world through touch.

In disorders that affect the nervous system, like shingles (the herpes zoster virus and chickenpox virus), diagnosis is communicated with references to the dermatome affected. In the illustration of shingles, the condition has tendencies to emerge on dermatomes in the trunk of the body. Other afflictions, acne for example, likes to pop up on the facial dermatomes.

Chart of the Body’s Dermatomes

All nerves originate from the spinal column that runs down the back. There are 31 spinal nerves including 12 thoracic, 8 cervical, 5 sacral, 5 lumbar, and 1 coccygeal. All spinal nerves are connected to a dermatome, except for one cervical nerve (C1). To simply classification, each of the body’s dermatomes is classified with a letter and a numeral according to the location and source spinal nerve. Here is how that pattern works:

C is for cervical nerves which are attached to the vertebrae in the neck. Shingles regularly appears in the c2, c3, and c6 dermatomes. The following are the corresponding dermatomes to body parts:

  • C2 – Top of the Head and neck
  • C3 – Nape of the neck
  • C4 – Neck and collarbone
  • C5 – Top of chest and front of arms
  • C6 – Side of the arm into the Thumb
  • C7 – Middle finger and index finger
  • C8 – Little finger and ring finger

The thoracic bundle is tied to the upper torso like the chest, arms, and hands.

  • T1- Inner forearm
  • T2 – Upper inner arm
  • T3 – Middle of the back or dorsal area
  • T4 – Chest across the nipples
  • T5 – Just below nipple level, bra area for women
  • T6 – Ribcage bottom
  • T7 – Upper section between the xiphoid process (sternum) and the belly button
  • T8 – From the xiphoid process to the belly button
  • T9 – From the middle section of the xiphoid process to the belly button.
  • T10 – Band across the belly button (umbilicus)
  • T11 – Bellow belly button to the groin (inguinal ligament)
  • T12 – Midpoint of the groin

The lumbar dermatome group is associated with the bottom appendages like the lower back, legs, hips, and partially the feet.

  • L1 – The hip and groin
  • L2 – The inside of the thigh
  • L3 – Knee
  • L4 – The inside of the ankle (medial malleolus)
  • L5 – Bottom of the foot and toes 1-3

The final section is the sacral dermatomes that connect to the feet and genitals.

  • S1 – Pinky toes and the outside part of the ankle bone (lateral malleolus)
  • S2 – The outside (lateral portion) of the heel bone (calcaneous)
  • S3 – Buttocks, perianal area, penis, and scrotum in men or vagina in women
  • S4 – Partial taint coverage and genitals
  • S5 – The anus and surrounding skin

Can You Have Shingles in Multiple Dermatomes?

We tend to think of shingles as a skin rash, when it, in fact, it is a nerve infection. The blisters and scabs are only the surface symptoms of the infected nerves. The virus travels within the nervous system and branches out into the epidermis. Shingles can be identified by its signature “belt” that marks a singular line across one side of the torso in a handful of dermatomes. Can you have shingles in multiple dermatomes?

Yes, the rash can spread across various dermatomes, especially the ones that are close together on the chest. While the outbreaks tend to stay isolated to a select few areas on the majority of patients, shingles can crop up anywhere on the body.

Dermatome Map of Shingles

Shingles can perform differently depending on the area it infects. In this dermatome map of shingles, we will cover a few prominent symptoms.

A shingles invasion into the T1 dermatome has, in some case studies, resulted in significant weakness in the hands. Shingles moving into the L1 dermatome is sometimes misdiagnosed as arthritis or fibromyalgia, but can be identified through thermal patterns. The lumbar dermatome is a complicated area to diagnosis because of the wide range of possible aggravations. It is also challenging to treat the tissues deep within the buttocks, hips, and lower back.

Shingles Dermatome Map of the Face

We covered the spaces throughout the body, but the face also has its own set of dermatomes. Facial dermatomes are linked to the cranial nerve. That list is organized as follows:

V1 – Forehead, scalp, cornea, eyelid, and dorsum (bridge) of the nose
V2 – Conjunctiva, lower eyelid, septum, lateral nose (cartilage and nostrils), upper lip, cheeks, and the mucous membranes surrounding some teeth.
V3 – Chin, lower lip, tongue, and external ear
Covering specifically the shingles dermatome map of the face, each V-section is afflicted with the virus in a different way.

In V1 the Ophthalmic Herpes Zoster (shingles of the Ophthalmic Nerve) infects the trigeminal nerve particularly. The tissues in the eye, and sometimes forehead, become severely inflamed. In untreated or severe cases, scarring can occur and lead to blindness.

In the V2 dermatome, shingles can cause a division between the V2 and V3 nerves that manifests in Odontogenic (teeth) pain.

 

 

Article References:

  1. https://www.medscape.com/answers/1878388-87146/what-are-dermatomes
  2. https://www.emedicinehealth.com/dermatomes/article_em.htm#what_are_dermatomes
  3. https://www.innerbody.com/anatomy/skeletal/xiphoid-process-sternum
  4. https://dphhs.mt.gov/Portals/85/dsd/documents/DDP/MedicalDirector/Shingles.pdf
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643045/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556918/
  7. https://www.allaboutvision.com/resources/conjunctiva.htm
  8. https://www.merckmanuals.com/professional/eye-disorders/corneal-disorders/herpes-zoster-ophthalmicus
  9. http://www.jcda.ca/article/e42

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