Shingles, also known as kayap in malay, is caused by reactivation of varicella-zoster virus infection commonly leads to a painful condition such as skin blisters and rashes. In some circumstances, shingles may affect other body systems rather than the skin. These consequences of the disease are commonly referred to as the internal shingles or systemic shingles.

The Internal shingles are having some distinct symptoms and it depends on which organs and systems are involved. Following are some of the specific shingles risk factors, as well as the symptoms that may develop when the virus affects other than the skin.

The Common Symptoms Of Internal Shingles

Internal shingles have certain similar symptoms with skin shingles, such as:

  • Severe pain over the site of affection
  • Blisters, itchy and burning sensation, especially over the skin rashes
  • Fever and chills
  • Headache, photophobia (sensitive to lights)
  • Muscle Ache
  • Lethargy
  • Tingling and numbness
  • Lymph nodes enlargement

In contrast to these, the internal shingles symptoms vary depending on which body system is involved. For example, the eyes, neurological system, lungs, liver, and brain are among the body systems that may be affected by shingles. When shingles affect the internal organs, it is considered a significant complication that needs immediate medical attention. Therefore, always suspect internal shingles whenever a patient suffers a more severe form of symptoms.


The nerves in the face are affected in about 10 to 25% of all shingles cases. The eyes are innervated by a branch of these nerves. When this happens, the infection can cause ocular and corneal damage, as well as considerable inflammation in or around the eyes.

Post-herpetic Neuralgia

Roughly around one in every five people who suffer shingles will develop post-herpetic neuralgia. During a shingles infection, the nerve fibres that have been inert by the virus become inflamed. This results in abnormal neuronal impulse transmission causing pain along the nerval tract. However, this pain may persist in certain cases after the infection is resolved, this condition is post-herpetic neuralgia.

It can cause chronic localised pain, numbness, and tingling for months after the shingles blisters healed. On-and-off pain and heightened sensitivity to touch are possible symptoms as well. In more severe situations, the symptoms might linger for weeks or even months. Prevention of this is possible by receiving the shingles vaccine or early diagnosis and treatment.

Ramsay-Hunt Syndrome

Also known as herpes zoster oticus, which happens when the herpes zoster virus reactivates within the branch of facial nerves that are responsible for hearing. This may result in hearing loss, facial paralysis, general facial pain and severe ear ache. This disease is usually transient and will go subsided on its own. However, shingles should be treated by a doctor, especially if it affects the face and neck.

Other Organs And Systems

Uncommonly, the shingles may affect other systems as well. This may lead to more severe issues, which can be fatal. It can cause pneumonia in the lungs. It can cause hepatitis in the liver and encephalitis in the brain. These are dangerous complications which necessitate immediate medical care, treatment, and hospitalisation.

Risk Factors Of Internal Shingles?

There are many risk factors which similar to the common skin shingles, which include:

  • Immunosuppressive conditions, such as chemotherapy, prolonged steroid therapy and radiotherapy.
  • Elderly, age over 60 years old.
  • Immunocompromised conditions in certain diseases, such as HIV infections with AIDS, autoimmune diseases and others.

How To Diagnose Internal Shingles?

Doctors will normally assess the symptoms first, as they do with most other conditions. A detailed history and description of the symptoms may be necessary. However, the Internal shingles may be suspected if your symptoms extend beyond your skin. Based on the location of the shingles rash, they will usually suspect an ocular or other nerval involvement. If the symptoms included painful rashes, severe cough, headache, or abdominal pain, it may be a more severe form of shingles infection.

To confirm the diagnosis of shingles infection, your doctor may order certain tests and investigations, such as direct fluorescent antibody stain, polymerase chain reaction, and viral culture. After the final diagnosis is obtained, then only a treatment strategy can be devised.

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