Nerve Paths That Shingles Follow: Dermatomes Map

You probably received a vaccine against shingles when you were a child. It is a common childhood disease. In later years, you may experience a reactivation of the varicella-zoster virus, which causes this condition and manifests as a shingles rash.

Let's go over what shingles are and the nerve paths it follows. This post will also explain the dermatomes map, how it helps manage vesicular rashes, and the risk of shingles complications.

What are shingles?

Shingle is a disease caused by the varicella-zoster virus, the same virus that causes chickenpox. Chickenpox is a common illness in children and is generally mild, with symptoms that include a fever and a rash that eventually goes away. The virus lies inactive in your nerve cells after the chickenpox infection subsides.

Herpes zoster, or shingles, is a skin rash with severe pain caused by the varicella-zoster virus reactivating as your immunity declines with age. The virus travels along the nerve paths to your skin, causing a painful, itchy rash that lasts 3–5 weeks. The rash can also lead to blisters that may leave scars.

Shingles most often occur in people over 50, but it can occur at any age. It is more common in women than men. The shingles rash is more likely to occur in immunocompromised patients, like those with cancer or HIV/AIDS, and those taking certain medications such as steroids or chemotherapy.

How are shingles transmitted?

The varicella-zoster virus is spread through direct contact with the rash or, more rarely, through the air when an infected person coughs or sneezes. You can also get shingles by coming into contact with the fluid from a shingles blister.

A child with chickenpox could increase an older adult's risk of contracting this painful rash because the varicella-zoster virus manifests as shingles in people over 50.

However, an older adult with this viral infection does not pose a risk to children because the chickenpox immunity generally acquired during childhood would protect them.

How are shingles diagnosed?

Shingles are typically diagnosed based on the appearance of the rash and painful areas. A skin biopsy or viral culture may be necessary to confirm the diagnosis. Another way to test for the virus is through a blood test.

What are the risk factors for shingles?

Shingle is a condition that everyone should try to prevent. The virus is already within you waiting to be reactivated, or you could get it from kids with chickenpox. How well you take care of yourself determines how fast you age and how healthy you will be in your older years.

However, time takes a toll on everyone eventually. Did you know that your odds of dealing with shingles increase as you age, and 33% of people have shingles at some point in their lives? Most people who get shingles are over 50 years old.¹

How does immunity affect shingles?

Your immune system protects you from infection by overcoming harmful bacteria, viruses, and other invaders. However, some complications weaken your immunity, making it easier for you to get sick. 

Immunocompromised patients often:

• Have cancer

• Suffer chronic stress

• Take certain medications (such as corticosteroids and chemotherapy drugs)

• Have HIV/AIDS

• Are malnourished

• Are submitted to radiation therapy

It is of paramount importance to keep your immunity levels up to avoid getting sick in the first place. A healthy, balanced diet coupled with an active lifestyle helps you maintain a strong immune system.

Is there a shingles vaccine?

Yes, there is a shingles vaccine that can help prevent the virus from reactivating. The shingles vaccine is most effective in people over 50 years of age.

What is a shingles nerve pathways map (dermatome map)?

Shingles nerve pathways maps are diagrams that show the path that nerves take as they innervate the skin. These maps can help understand how herpes zoster virus travels along nerve pathways and can help to explain why the rash of shingles typically occurs in a band-like or stripe pattern.

Are there common shingles nerve pathways maps?

The cranial nerves exit directly from the brain. On the other hand, the spinal nerves exit from the spinal cord. Everyone has 31 pairs of spinal nerves and 12 pairs of cranial nerves. Each skin area (dermatome) is innervated by one of these nerves.  

The most common nerve path that shingles follow is the thoracic dermatome. The thoracic dermatome is a band of skin supplied by sensory nerves exiting from the spine in the thoracic region. 

The rash associated with shingles typically starts as a band of raised red bumps on one side of the neck and chest and often wraps around the side to the back.

A shingles rash can also occur along the path of other sensory nerves, such as cranial and cervical. The rash associated with shingles on these nerve paths is typically less severe than the thoracic dermatome rash.

What are the cranial nerve paths that shingles follow?

The varicella-zoster virus travels along these nerve paths to your skin:

The trigeminal nerve, the 5th cranial nerve

This nerve innervates the face, scalp, teeth, and mucous membranes of the mouth and nose. The chickenpox virus travels along this nerve to cause herpes zoster ophthalmicus, which causes a rash around the eye.

The facial nerve

It's the 7th cranial nerve and serves the muscles of facial expression and the lacrimal and salivary glands. The chickenpox virus can travel along this nerve to cause a rash around the ear.

The 9th cranial nerve

Also called the glossopharyngeal nerve, it supplies the tongue, pharynx, and larynx. The chickenpox virus can travel along this nerve to cause a rash in the throat.

The vagus nerve

It's the 10th cranial nerve and innervates the heart, lungs, and digestive organs. No other cranial nerve is longer or more complex than the vagus nerve. The chickenpox virus can travel along this nerve to cause a rash on the chest or abdomen.

The dorsal root ganglia 

These are clusters of nerves located along the spinal column. The varicella-zoster virus travels along these nerves to cause a rash on the trunk, back, or buttocks.

What are the symptoms of shingles?

The most common symptom of shingles is a painful, itchy rash that can appear anywhere on your body but most often appears as a stripe of blisters wrapping around one side of your torso. Other symptoms of shingles include:

• Fever

• Headache

• Fatigue

• Sensitivity to light

• Nausea

• Stomachaches

The symptoms of shingles can be mild to severe. Some people with shingles only have a rash, while others may experience more severe symptoms such as fever and headaches.

What is the difference between shingles and chickenpox?

Herpes zoster and chickenpox, though caused by the same virus, are different diseases. Chickenpox is a mild, contagious childhood disease characterized by a rash of itchy blisters.

Shingles are a reactivation of the chickenpox virus that manifests as a painful, itchy rash in older individuals.

What are the complications of shingles?

The most common complication of shingles is postherpetic neuralgia. It is a condition that causes persistent burning pain after the rash has healed. Other complications of shingles include:

Pneumonia

The varicella-zoster virus can cause pneumonia, a severe lung infection in people with weakened immunity.

Cranial nerve damage

Ramsay Hunt syndrome is a rare complication of shingles that can cause paralysis of the facial muscles and hearing loss. Blisters around your ears can also lead to Bell's palsy, further complicating your facial muscles.²

Labyrinthitis

Labyrinthitis is an inflammation of the inner ear that can cause vertigo or a spinning sensation. This condition often goes away alone, but it can be severe and require medication to treat.

Encephalitis

The varicella-zoster virus can also cause encephalitis, an inflammation of the brain, as it travels along the nerve paths to your brain. Encephalitis can be deadly.³

Motor nerve damage

Up to 5% of people who suffer from shingles develop segmental zoster paresis, which results in muscle weakness or paralysis on one side of the body.⁴

Shingles can also cause post-zoster opsoclonus, characterized by rapid, uncontrolled eye movements.

Myocarditis

Myocarditis is an inflammation of the heart muscle. Rarely, the varicella-zoster virus causes myocarditis, but it is possible. Myocarditis can also be fatal.

Vision loss

Clusters of water-filled blistering rashes on or around your eye can cause vision loss if left untreated. Shingles manifesting around your eye is called herpes zoster ophthalmicus and can blind you in that eye if not treated quickly and aggressively.

Treating nerve damage from dermatomes shingles

Medical experts are likely to start by drawing a dermatome map to determine the source and severity of the nerve pain. It helps to rule out other possible causes of the pain, such as a herniated disc or arthritis.

A shingles outbreak may manifest in one or two dermatomes. The most common site for a shingles outbreak is on the torso, but it can also appear on the face, neck, and legs.

The rash and pain of shingles can be so severe that it interferes with your daily activities.

There are a few ways to ease the pain and help your nerve damage heal:

Antibiotics

Antibiotics may be prescribed if the person has a bacterial infection that develops as a secondary infection along with the herpes zoster virus.

Antiviral treatment

These drugs can help shorten the duration of the virus and lessen the severity of symptoms from the incidence of zoster.

Corticosteroids

These drugs can help reduce inflammation and pain.

Pain medication

Over-the-counter or prescription pain relievers can help ease the pain of shingles.

The lowdown

Shingles can be painful and debilitating, but treatments are available to help ease the symptoms. It helps to see a doctor as soon as possible if you think you may have shingles so that you can begin treatment and prevent further complications.