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 Bells palsy must be instructed to return or see their GP should a rash develop later.