Mild Case of Shingles Rash

Can shingles be mild?

Shingles (herpes zoster) usually causes severe symptoms, but it occasionally presents with only mild pain and rash, rash without pain, or pain without rash.

Shingles will be more likely mild ^[1,2]:

• In children and young adults
• When developing within 5 years after herpes zoster vaccination
• When treated with antivirals within 72 hours of symptoms onset

Picture 1. Mild shingles on the face
(source: DermNetNZ, CC license)

Picture 2. Mild shingles on the chest
(source: Preston Hunt, Wikimedia, CC license)

Picture 3. Mild shingles in the upper back
(source: da Silva SF, MD, Dermatology Atlas)

Picture 4. Mild shingles in the lower back
(source: Wikimedia, CC license)

How long does mild shingles last?

According to anecdotal reports, in mild shingles, both the pain and rash can disappear within 2 weeks. However, sometimes the pain can persist for months after the rash has healed. Shingles that are mild are not necessary short in duration.

Can shingles appear with a rash but no pain?

Occasionally, mainly in children, shingles can appear with a rash but no pain ^[3].

Picture 5. Shingles rash on an arm in a child
(source: Wikimedia, CC license)

Can shingles appear with pain but no rash?

Shingles usually starts with pain that lasts for 2-3 days (or up to 3 weeks) before any rash appears ^[6]. Rarely, the pain, which can be severe and can persist for a month or longer, remains the only symptom and no rash develops, which is medically known as “herpes zoster sine eruptione” or “zoster sine herpete” ^[4]. Skin and other tests are available to confirm the diagnosis.

What does shingles rash in an early stage look like?

The first signs of shingles include red patches (erythema) and raised flat bumps (papules). The next rash stages include blisters, ulcers and crusts. The rash tends to appear at the back first and then spreads in the form of stripe toward the front or down the limb ^[5].

Picture 6. Shingles rash in an early stage
(red patches and papules only, no blisters)
(courtesy of Dr. Gary White, RegionalDerm.com)

• References

  1. Janniger CK, Herpes zoster, overview  Emedicine
  2. Harpaz R et al, 2008, Prevention of Herpes Zoster; Recommendations of the Advisory Committee on Immunization Practices (ACIP)  CDC.gov
  3. Herpes zoster DermNetNZ
  4. Ku SH et al, 2014, A case of zoster sine herpete presenting with thoracic radicular pain diagnosed by polymerase chain reaction in skin exudate  ScienceDirect
  5. Herpes zoster  FPNotebook
  6. Stankus SJ et al, 2000, Management of Herpes Zoster (Shingles) and Postherpetic Neuralgia
     American Family Physician