Shingles is a disease of the nervous system that is caused by the varicella-zoster virus. This is the same virus that causes chicken pox. Shingles can be mistaken for a skin infection, as it presents with a painful rash and blisters on localized body areas.
Only people who have had chicken pox in the past can get shingles. Before the rash and blisters, other symptoms such as fatigue, nausea, pain, tingling and itching may be present. In fact, the rash may not materialize at all. Symptoms without the rash are mostly seen in the case of internal shingles.
There is no cure for shingles. Medications are however available which seek to shorten recovery period and improve shingles symptoms. Patients are advised to seek medical help within 72 hours of first symptoms. In this article, we seek to understand the shingles dermatome map, shingles pattern and commonly affected body areas.
Can shingles affect more than one dermatome?
Is it possible to have shingles on multiple dermatomes? In most cases, shingles occurs on one dermatome. It is not uncommon for adjacent dermatome to also be affected. To understand why this is so, let’s look at how shingles occurs.
A good number of people had chicken pox when growing up. After a person recovers from chicken pox, some varicella-zoster virus hides in nerve fibers that innervate certain dermatomes. The virus remains there until reactivated, in which case shingles occurs.
A dermatome is an area of the skin supplied by nerves from a single spinal root. There are 31 pairs of peripheral nerves that arise from the spinal cord in humans. There are 8 cervical, 12 thoracic, 5 sacral, 5 lumbar and 1 coccygeal. Each pair serves a particular part of the body.
If it happens that the herpes zoster virus affects a thoracic nerve, for example, you can have shingles on the breast symptoms, below the breast, and so on. But since the virus doesn’t affect both nerves serving the same areas on the two sides of the body, signs will only occur on one side. Sometimes, the herpes zoster virus can migrate to an adjacent nerve. This happens when a particular nerve divides into several branching terminals. A good example is the trigeminal nerve which branches into three terminals. But as mentioned earlier, shingles in multiple dermatomes is not common.
Most cases occur on the face, lower back and trunk. Any part of the body can however be affected. In people with serious immune issues, disseminated shingles can occur. This is where signs are not localized but occur in multiple areas. Such serious cases can result in fatal complications. Check out the history of shingles ICD 10 for more details.
Cervical shingles dermatome map; C1, C2, C3, C4, C5, C6, C7, C8
Understanding how cervical nerves are outlined can help with self-diagnosis for shingles. Below is a summary of cervical shingles dermatome map:
- C1, C2 and C3 – these three cervical nerves serve the head and neck areas. Any case of shingles on head, neck or face is due to herpes zoster infection in one or several of these nerves. C1 doesn’t serve any dermatome, however.
- C4 – this nerve serves the neck and the areas above the rib cage. If shingles occurs on the neck, shoulders and chest, it most likely involves this nerve.
- C5 – the dermatome served by C5 covers the shoulders and arms to about where the wrist starts.
- C6 – dermatome covers side of the arm, side of hand where thumb is located and top of shoulders.
- C7 – dermatome covers back of arm, shoulder, and hand along middle finger. Shingles on fingers symptoms usually involve herpes zoster virus in C7 dermatome.
- C8 – dermatome covers the upper side of hand, arm, and shoulder on lower side.
The trigeminal nerve is the largest cranial nerve. It branches into 3 terminals:
- Ophthalmic nerve – innervates the skin on scalp, forehead, cornea, upper eyelid and tip of the nose. Collectively, these areas can be referred to as V1 dermatome. Herpes zoster virus often causes infection on this dermatome. This is why shingles symptoms eye are common.
- Maxillary nerve – this nerve innervates the V2 dermatome. V2 dermatome includes the nose, lower eyelid, conjunctiva, cheeks, upper lip and maxillary teeth.
- Mandibular nerve – this nerve serves V3 dermatome. This includes lower lip, tongue, outer ear and chin.
Thoracic shingles dermatome map; T1 –T12
Thoracic dermatomes are located on the upper torso.
T1 dermatome covers the inner forearm while T2 covers upper arm on the inner side. T3 covers the dorsal part of middle back while T4 covers the area that levels with the nipples. T5 covers the area from under the breast to the end of the ribcage. T6 is a bit different for it covers the foot at the bottom side. T7 covers the area from where T6 dermatome ends at the navel while T8 dermatome starts where the rib cage ends to just level with the navel. T9 runs from just above the diaphragm to lower abdomen while T10 levels with the navel. T11 starts from just below the navel to groin region while T12 covers the middle of groin.
Lumbar shingles dermatome map; L1-L5
There are 5 lumbar dermatomes which serve the lower body. L1 dermatome covers the groin and hip. L2 covers the thigh on the inside while L3 covers the knee. L4 covers the ankle area on the inside part while L5 covers the foot and first 3 toes on the bottom side.
Sacral dermatome map shingles pattern; S1-S5
If shingles is to occur on sacral dermatomes, it would follow a pattern dictated by the following dermatomes:
S1 covers the last two toes and also extends to the ankle bone. S2 covers the heel on the outer side. S3, S4 and S5 cover the genital areas, including the buttocks and perianal areas.
The last spinal nerve or coccygeal nerve serves the dermatome at level of the coccyx.
On pictures, you will realize that dermatomes are shaped like long bands or stripes. If one of them is to be affected by shingles, a rash will appear along the affected dermatome. This is one of the defining characteristics of a shingles rash.
Symptoms and treatment of shingles on different dermatomes
A shingles outbreak begins with flu-like symptoms. These include fatigue, nausea, vomiting and headache. There may be fever but most patients complain of a predominant fever. A day or two after these symptoms, pain, tingling or itching will develop on affected dermatomes. This occurs as herpes zoster virus migrates from the nerves towards the skin.
Rash and blisters appear 2-3 days after first symptoms. At first, the blisters present as spots which soon develop into lesions and ultimately into blisters. The blisters often rupture and ooze before crusting over. How long does it take for shingles to heal? The whole process takes 2-4 weeks. Without treatment or when severe cases are involved, outbreaks can last longer.
There are various options of how to treat shingles in adults. These include:
- Antiviral drugs
- Pain relievers
- Tricyclic antidepressants
- Home remedies
- Homeopathic cures
Prescription medicines are always the best option to start with. This is especially when post-herpetic neuralgia is involved. Post-herpetic neuralgia is a condition that results in prolonged shingles pain. For mild cases such as shingles headache treatment, over the counter pain killers may be enough. Home treatments help improve symptoms such as itchiness and skin irritation.
You can also consider shingles vaccine. Currently, there are two shingles vaccines that have been approved by the FDA. These are zostavax and shingrix. Both are recommended for people over age 60.
People who have never been vaccinated against chicken pox are also urged to get the shot. This is especially for pregnant women or those planning to become pregnant. Shingles is not considered harmful to unborn babies but chicken pox is.
Common Drugs for Shingles: Acyclovir, Valtrex, Lysine and Gabapentin
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