Ramsay Hunt Syndrome: Zoster Sine Herpete

The image shows facial paralysis, post herpes zoster (reproduced with permission from Wellcome Images).

Zoster sine herpete is a term for Ramsay Hunt syndrome without apparent vesicles or when there is a delayed presentation of the rash.

Learning bite

In 15% of patients with Ramsay Hunt syndrome, vesicles develop after the onset of facial weakness [4] and therefore patients diagnosed with Bell’s palsy must be instructed to return or see their GP should a rash develop later.