Shingles Part I: Understanding the Viral Phases
1. PRODROMAL PHASE: Prodromal refers to the initial phase of an illness, the interval between the earliest symptoms and the appearance of a rash. In the case of Herpes Zoster, this phase can last a few days to 3 weeks before a rash actually appears (typically 4 to 5 days). Pain lasting longer than 3 weeks has been reported and this can cause difficulty in differentiating the source of the pain until the characteristic rash erupts (pre-herpetic pain has been mistaken for migraine, pleurisy, abdominal disease or cardiac pain). Recognizing that shingles pain follows the dermatome can help diagnosis in this early stage. Patients and practitioners take note: we can achieve the best clinical results if we begin treatment (such as herbs) during this initial phase. Be aware that there is a version of shingles in which no lesions actually manifest on the skin. This is called zoster sine herpete and will present similar to the prodromal phase of herpes zoster without the visible rash ever coming out to the surface. It often gets misdiagnosed. Look for one-sided pain (along the rib cage, at the sternocostal joints of ribs, down one leg or one side of the face) that the patient reports as severe, burning, searing, disproportionately tender or sudden and intense, when they cannot recall any trauma or physical activity as a possible trigger. Skin Symptoms to watch for: (most often on the sides of the torso, on the chest, along the spine, on the lower back, but possibly on the face (usually forehead) or limbs)Herpes Zoster (a.k.a. Shingles) is an acute skin infection associated with the reactivation of the varicella-zoster virus (the virus that causes chickenpox). During chicken pox infection, the virus enters the cutaneous nerves and then travels to the dorsal root ganglia where it lies dormant until something triggers it to become active again. Stress, illness, emotional upset, T-cell immuno-suppressant drugs, fatigue and radiation therapy (any circumstances that compromise a patient’s immunity) can trigger the latent virus to travel back down the sensory nerve to infect the surface of the skin (along a single dermatome). There are 3 distinct clinical phases of shingles: prodromal, active, and chronic.
- Pain (sharp, stabbing, pricking, and/or shooting)
- Heightened sensitivity to mild stimuli
- Slight fever
- Decreased appetite
- Regional lymphadenopathy (swollen lymph nodes)
Topics: Herpes & Shingles, Rashes
Publish Date: February 19, 2012 *Articles may include updates since original publishing.
About the Author (Author Profile)Diana Hermann is a licensed acupuncturist and board certified in Chinese Herbal Medicine. She received her Master Degree in Acupuncture and Oriental Medicine from the Oregon College of Oriental Medicine in Portland, OR and trained in China at the Nanjing University of Traditional Chinese Medicine. Diana treats patients in her Fort Collins, Colorado clinic and hand crafts herbal skin care products for her company Zi Zai Dermatology. In 2015, she completed the Diploma In Chinese Medicine Dermatology program from Avicenna in London, UK. She completed the program for a second time in 2019 in Chicago.
Sites That Link to this Post
- What Having Shingles Felt Like and How I Treated It | Zi Zai Dermatology's Blog | February 28, 2012
- Shingles Part II: TCM Differentiation and Treatment | Zi Zai Dermatology's Blog | March 29, 2012
- Childhood varicella vaccination not linked with greater adult herpes zoster … – 2 Minute Medicine | Shingles News Today | December 3, 2013