Tingling on back of thigh

[lisa345]

Hello,

Three and a half years ago, I had a rash on the back of my upper thigh that was diagnosed as Herpes Zoster, on examination. I did not have blood work or viral culture to confirm. I have not had any symptoms since (no blisters, redness, itching, etc.) in that area or elsewhere since then, although I did have some neurologia shortly after. However, for the past 4 days, I have felt a tingling sensation on the back of my thigh that is very pronounced when sitting down. I do not feel it when I am standing or walking. I sit for a lot of hours at work, and noticed it after a particularly long day. I am very worried because it is in the exactly same spot where I had the HZ. There are definitely no sores or redness present. However, could this be suggestive of an outbreak of HSV1/HSV2 and misdiagnosis of Herpes Zoster?

[Edward W Hook, MD]

HSV as well as Zoster can casuse sensations of the sort I think you may be descrbing . In the case of HSV this is called a "false prodrome" while in zoster it is neuropathic.  For it to have lasted several days or more is not suggestive of a HSV false prodrome.  As I said, there are other possible casues as well; that is the reason I suggested discussion with your doctor.   EWH

[lisa345]

Thank you very much for your response. I actually don't have a visible rash on my thigh; I just feel a lot of tingling (and no itching, just a little bit of pain) in the area where the HZ once was. For this to be a recurrence of HSV, would I have to have skin manifestations?

[Edward W Hook, MD]

Welcome to the Forum.  As you imply, HSV can mimic Herpes Zoster when it occurs at non-genital areas and without a culture it is sometimes hard to determine which is causing a rash such as the one you had 3.5 years ago.  The time course with neuralgia following the initial outbreak is certainly consistent with zoster.  In addition however, I would also point out that there are many other things that can also cause the sort of discomfort you are currently experiencing at your thigh, amongst them back strain brought on by a long day at work.  

Regarding your current rash, i would also point out the zoster can recur, as does HSV.  In fact about 20% of persons who have had zoster will get a recurrence.  My advice at this time would be to go see your doctor, preferably the one who say you for your prior episode (continuity is a good thing). The sooner you can see him/her the better since if this is indeed zoster the sooner therapy is started the more relief you will get.  My guess this is recurrent zoster but without the opportunity to evaluate you directly this is just a guess.  The answer lies with your doctor.  

Hope this helps. EWH