Herpes zoster--more commonly known as shingles--is the reactivation of a previous infection with the Varicella-zoster virus (VZV). When you first contract VZV, it causes chickenpox. During recovery from chickenpox, VZV does not leave the body but rather becomes dormant in the nerves. Herpes zoster occurs when VZV is reactivated. Herpes zoster has a pre-eruptive phase, which occurs before the rash appears, and an eruptive phase with blistering skin lesions. The early symptoms of herpes zoster occur during the pre-eruptive phase of the illness. The Centers for Disease Control and Prevention (CDC) estimates 500,000 to 1 million cases of herpes zoster occur annually in the United States.
Fever and Chills
Fever is a common early symptom of herpes zoster. Chills may also occur. These symptoms generally last throughout the illness.
Headache, Malaise and Fatigue
Headache may occur during the pre-eruptive phase of herpes zoster. A generalized sense of feeling ill, or a malaise, and unexplained tiredness are also typically present. According to the CDC, the pre-eruptive phase of herpes zoster typically lasts two to four days before the first skin lesions of the illness appear.
Nausea and Diarrhea
Nausea may occur as an early symptom of herpes zoster. Some people experience queasiness rather than outright nausea. Mild diarrhea may also occur.
Localized, Abnormal Skin Sensations
The hallmark early symptom of herpes zoster is the presence of abnormal skin sensations located in a specific area on one side of the body. You may feel tingling, burning, itching or pain. These sensations range in intensity from mild to severe. They occur along a band of skin, commonly starting on one side of the back and extending around to the waist. Alternatively, the sensations may occur on one side of the face including the forehead and the skin surrounding the eye. If the face is involved, the eye on the affected side may be irritated and red. Less commonly, herpes zoster occurs in other body sites such as one arm or one leg.
Red Skin Spots
As herpes zoster transitions from the pre-eruptive to the eruptive phase, flat red spots appear in the skin area affected by abnormal sensations. These spots develop into raised bumps marking the beginning of the eruptive phase of the illness. The National Institutes of Health reports some cases of herpes zoster do not progress to the eruptive phase. This variant of herpes zoster, when no skin lesions develop, is called zoster sine herpete.
References
- Centers for Disease Control and Prevention, Pink Book: Varicella
- Centers for Disease Control and Prevention: Shingles In-Short
- National Institute of Neurological Disorders and Stroke: Shingles Symptoms
- Penn State Milton S. Hershey Medical Center: Herpes Simplex and Zoster
- "Principles and Practice of Infectious Diseases, Sixth Edition"; Gerald L. Mandell, M.D., et al, Editors; 2004
