Internal Shingles: Painful Symptoms, Treatment and How Long it Lasts

Invisible disease compounds the struggle of chronic illness with social stigma. If you don’t look sick, you can’t get sympathy from others and could fall prey to judgment from those who think you are faking it. You might even begin to wonder yourself if it is all in your head.

Even viral infections that normally exhibit visual cues, like the shingles rash, can manifest internally with no visible symptoms. This creates challenges on diagnosis, treatment, and healing. But we are here for you on the journey with scientifically backed information and resources. Please read on to learn more about internal shingles.

Can Shingles Be Internal?

While traditionally, shingles are associated with the blistering rash, you may be surprised to encounter the phenomenon of rash-less shingles. Can shingles be internal? That would be an affirmative. It is rare, but the virus can grasp onto internal organs for the systemic shingles.

Internal shingles without the rash is a condition dubbed zoster sine herpete (ZSH). It falls under the same umbrella as other viral infections in the herpes family. Larger numbers of diagnoses have happened in recent years due to the emergence and prominent use of the Shingrix vaccine.

Clinical trials of the shot have unearthed multiples examples of internal shingles, according to the director of the nerve unit at Massachusetts General Hospital. The studies revealed the weaknesses that elevate risks of succumbing to ZSH, and they include:

  • Debilitated immune system, usually attributed afflictions like HIV/AIDS, lupus, rheumatoid arthritis, and inflammatory bowel disease.
  • Cancer treatments. Chemotherapy and radiation weaken the immune system.
  • Age of 60 plus.
  • Medications. Taking organ transplants drugs like tacrolimus (Prograf) and cyclosporine (Sandimmune), as well as steroids, will increase the risk of shingles.

What are the Symptoms of Internal Shingles?

If there is no rash, how can doctors know a person is sick with HSV? What are the symptoms of internal shingles to watch for?

Symptoms include:

  • Chills
  • Fever
  • Chest or abdominal pain
  • Numbness and tingles
  • Itching
  • Swelling in the lymph nodes
  • Pain in the affected organs. Common targets include the liver, eyes, lungs, and brain.

Diagnosing Internal Shingles Without the Rash

Without the visual representation on the host body of the bubbly red rash, finding evidence of internal shingles is herculean. Symptoms are still an integral part of the diagnostic process and trained professionals will be able to recognize the signs easier than civilians can. On top of the symptoms, internal shingles without a rash can be tested by:

  • Direct fluorescent antibody stain. From a bodily sample, usually blood or a cotton swab, the lab introduces fluorescent material that binds to a particular antibody. This helps identify if the body is already fighting against an intruder, like the shingles virus.
  • Polymerase chain reaction. A laboratory technique that copies DNA to identify unwanted pathogens.
  • Virus culture. A sample of blood, urine, or bodily fluids is extracted and tested for the herpes zoster or zoster sine herpete virus.

How Long Does Internal Shingles Last?

Internal and external shingles share a list of symptoms, the same contagious nature, and a similar outlook on duration. How long does internal shingles last?

The majority of cases will exonerate within 2 to 6 weeks. Early detection and aggressive treatment can speed up the healing process and reduce the risk of lingering nerve pain, a common side-effect.

Internal Shingles Treatment

Prescribing an antiviral medication, like valacyclovir, acyclovir, or famcyclovir, at the onset of symptoms is typically the first step. Beyond that, internal shingles treatment relies on actions that boost the immune system. Stress is a major trigger for shingles and sufferers should take steps towards relaxation.

Additionally, some schools of thought support eating specified foods that are nutrient dense to induce healing. Noted foods include:

  • Leafy green vegetables
  • Orange and yellow fruits
  • Eggs
  • Fish
  • Chicken
  • Low-fat cheese
  • Legumes
  • Whole grains
  • Tomatoes

Drinking plenty of water is consistently a good idea as it is a pillar in the body’s waste management system. The fluids help the lymphatic system to detox the body and remove irritants contributing to the inflammation and pain. Flushing works best if you aim for at least 8 ounces every two hours.

Easing Internal Shingles Pain

Ultimately the body is responsible for overcoming the virus, but living with intense pain for six weeks isn’t realistic. A central tactic in the treatment process is minimizing internal shingles pain.

Doctor prescribed options include:

  • Capsaicin topical patch (Qutenza). Oddly, the element in chile peppers that burns your mouth also deadens nerve endings. It can also be applied in a topical cream, if the internal pain creeps to the surface.
  • Tricyclic antidepressants (amitriptyline, amoxapine, desipramine). Off-script use of certain antidepressants is effective at pain relief.
  • Lidocaine. This numbing agent can be administered via cream, gel, patch, or spray. Helps with itching too.
  • Narcotics/Opioids (codeine, etc.)
  • Anti-seizure meds (gabapentin, etc.). Neuropathy (nerve pain) responds well to these pharmaceuticals.

Many patients find natural approaches are a great substitute or augmentation of medical interventions. Those include:

  • Cool baths. Adding baking soda, oatmeal, Epsom salts, or essential oils can help with pain and relaxing.



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