It is possible for the zoster virus to activate and cause some of the symptoms of shingles without a rash appearing, according to the New York Times. This condition is called zoster sine herpete and is most common in the elderly.
When shingles activates but does not form a rash, skin symptoms include numbness, itching, tingling, and shooting or burning pain, and overall symptoms include fever, nausea and chills, reports the New York Times. Because of the lack of rash, diagnosis of this condition is frequently difficult. Research has shown that some diagnoses of Bell's palsy, in which the face is partially paralyzed, might instead be an instance of zoster sine herpete.
Pain is often the first symptom of shingles, whether the rash appears or not, and it is common to all shingles patients, notes the New York Times. It starts most frequently in the skin at the point where the virus reactivates. The pain often feels sharp, tearing and similar to that of an electric shock. After the pain begins, the skin sometimes itches, becomes numb or is intensely sensitive to touch. Sometimes, a combination of these symptoms occurs. Muscle aches and pains similar to those of the flu happen to some patients. This initial stage lasts up to five days, and if the rash is going to come, it comes at the end of this stage. Otherwise, the patient has zoster sine herpete.