Can you have shingles without a rash?
Q IS it possible to have a bout of shingles without the characteristic itchy rash? A
SHINGLES is caused by the same virus that is responsible for chickenpox. After you have chickenpox, the virus, herpes zoster, remains silently in the nerve roots next to the spinal cord. However, it can become active again and travel down a nerve root to the skin to cause an attack of shingles.
The first symptom is usually pain in the affected area of skin, which is also tender. Then two to three days later a rash usually develops which starts as red blotches that then develop into itchy blisters and look like chickenpox spots.
However both the pain and the rash only occur in the area supplied by the nerve, usually a band on one side of the body. There is a form of shingles, known as zoster sine herpete (ZSH), where the virus becomes active and causes pain but does not cause the typical rash.
It is fairly rare and the diagnosis may be missed because of the lack of the rash. It tends to affect the face, including the eyes and the neck more than the rest of the body.
No one knows why ZSH occurs rather than full-blown shingles with the rash. But treatment, with anti-viral tablets such as acyclovir, is the same. These are most effective if started as soon as possible after symptoms begin. Unfortunately, as with standard shingles, ZSH can cause persistent neuralgic pain afterwards from inflammation of the affected nerve.
Q WHAT causes a salty taste in the mouth? I have had this for several months now. A
A SALTY taste can occur when your mouth is dry and this can be a side-effect of a lot of medications (such as tablets for pain, depression or heart problems) and also a lack of the production of saliva.
Not drinking enough water can also be to blame, especially if you tend to drink coffee in the morning and alcohol in the evening, both of which can lead to dehydration.
Bleeding from your gums can also lead to a salty taste and this is most commonly due to inflamed gums, caused by poor dental hygiene (which is the polite way of saying you are not cleaning in between your teeth properly). I suggest your first port of call should be your dentist and if they can’t help then see your GP.
Q A IS CRYOTHERAPY the best way to treat a verruca?
IT DEPENDS what you mean by “best”. To some people best means quickest, to some the most convenient while for others it means the method with the least pain.
Verrucas are caused by the same viruses that cause warts but because of pressure from walking, the lesion grows into the skin rather than outwards.
This is why some people who have verrucas also find they have small warts in between their toes. There are lots of different ways of tackling verrucas but to begin with I suggest trying gels containing salicylic acid which can be bought from pharmacies.
These need to be applied daily but it is also important to file down the hard skin on the top of the verruca so the treatment reaches deeper into the skin. It shouldn’t hurt but you do have
to be patient as it can take several weeks of daily treatment for the verruca to disappear.
I’ve had patients who have said applying a small square of gaffer tape each day has worked just as well but I have no firm evidence to back this up.
Cryotherapy involves freezing the infected cells. You can buy this type of treatment, containing liquid carbon dioxide, over the counter from pharmacies. But in my experience it doesn’t work very well, especially on large or deep verrucas. Cryotherapy with liquid nitrogen, which is much colder, is more effective but it is also a lot more painful. You can’t do this yourself. It’s mainly done in hospitals and by podiatrists but some GPs do it as well.
It can be painful as you have to be able to withstand the verruca being sprayed at frost bite temperature for at least 20 seconds and I certainly wouldn’t use it for treating children under eight. It can cause pain and blistering afterwards and several sessions of treatment are usually required, two to three weeks apart.
If you have a health question for Dr Rosemary please write to her in confidence at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN or email health@express.co.uk
Dr Rosemary’s reply will appear in this column. She regrets that she cannot enter into personal correspondence and that, due to the volume of letters, she cannot reply to everyone. Find out more about Dr Rosemary at drrosemaryleonard.co.uk