How Do Dermatologists Diagnose Shingles
A dermatologist can often diagnose shingles by looking at the rash on your skin.
If there is any question about whether you have shingles, your dermatologist will scrape a bit of fluid from a blister. This will be sent to a lab where a doctor will look at the fluid under a high-powered microscope.
When you have shingles, the fluid contains the virus that causes shingles. Seeing the virus confirms that you have shingles.
Your dermatologist will also ask about your symptoms. Shingles tends to be painful.
When the shingles rash spreads to an eye, it can affect your eyesight
You can reduce this risk by seeing an ophthalmologist immediately.
Study Assesses Relief Options Against Shingles Pain
- Study Assesses Relief Options Against Shingles Pain
The painkiller oxycodone is effective at treating the acute pain of shingles, an illness that often causes severe pain which can become long-lasting and sometimes even permanent.
The study, published in the April issue of the journal Pain, is one of the first to carefully evaluate different methods to relieve pain during a course of shingles, which many patients say causes the worst pain they have ever experienced. Effective pain treatment is crucial. Not only can the pain of shingles disrupt peoples quality of life, but it is also possible that the less effectively the pain is treated, the more likely it will become a long-term problem that can change a persons life forever.
Shingles is caused by reactivation of the varicella zoster virus, the same bug that causes chicken pox, and only people who have had chicken pox are vulnerable to shingles. About 20 to 30 percent of people will get shingles at some point in their lives the odds climb to 50 percent for people who live to the age of 85.
For most patients, the first symptom of the infection is pain, quickly followed by a rash where the pain first appeared. The rash appears most often on one side of the chest or face, oftentimes causing dozens of small pimple-sized lesions. Some patients also get flu-like symptoms like a headache and lethargy. The illness usually lasts about three or four weeks.
Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
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Shingles And Postherpetic Neuralgia: What Are The Risk Factors
You can’t control whether you’ll catch the chickenpox virus. Fully 99.5% of adults in the U.S. carry it, whether or not they remember having had chickenpox. But why do one-third of those people get shingles — and some of them go on to develop postherpetic neuralgia?
The risk of postherpetic neuralgia also goes up with age. More than 80% of cases of postherpetic neuralgia occur in people over 50 years old. “It’s likely that the natural decline of immunity with age is responsible,” says Ralph.
The results of one study showed that age had a huge effect on the risk for postherpetic neuralgia after shingles:
- Among people under 60 years old who had shingles, less than one in 50 developed postherpetic neuralgia.
- In people aged 60 to 69, about 7% of shingles sufferers developed postherpetic neuralgia.
- In those age 70 and older, almost 20% developed postherpetic neuralgia after a bout of shingles.
Race seems to matter, too. For unknown reasons, white Americans get shingles and postherpetic neuralgia at more than twice the rate of African-Americans in their age group.
“People whose immune systems are impaired by drugs or diseases like AIDS are also more prone to zoster and PHN,” adds Ralph.
Exposure to someone with chickenpox or shingles does not increase your personal risk, however. In fact, experts believe that the slight immune stimulation may boost natural defenses, making you less likely to develop shingles or PHN.
How Long Does Shingles Last
Most cases of shingles last three to five weeks.
- The first sign is often burning or tingling pain sometimes it includes numbness or itching on one side of the body.
- Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
- A few days later, the rash will turn into fluid-filled blisters.
- About one week to 10 days after that, the blisters dry up and crust over.
- A couple of weeks later, the scabs clear up.
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Best Treatments For Lasting Shingles Pain
Postherpetic Neuralgia Pain: What Works, What Doesn’t
Doctors call it postherpetic neuralgia or PHN. It’s caused by nerve damage left behind by a case of shingles. Shingles itself comes from reactivation of a chickenpox virus, varicella zoster. The virus travels down nerve fibers to cause a painful skin rash.
When the rash goes away, the pain usually goes with it. But for 12% to 15% of people the pain remains. If your shingles pain lasts eight to 12 weeks after the rash goes away, you’re part of an “unfortunate minority,” says pain researcher Andrew S.C. Rice, MD, of Imperial College, London.
“Among people with PHN, some have their pain resolve in the first year to 18 months after the shingles rash goes away,” Rice tells WebMD. “But if they have pain longer than that, it is not going to go away on its own. In either case, a person must deal with the pain.”
Postherpetic Neuralgia Treatment: Soothing The Pain
Once postherpetic neuralgia occurs, antiviral drugs can’t treat the pain because ongoing infection isn’t the problem. Instead, treatment aims to soothe and quiet the misfiring nerves that are creating the pain.
There are a variety of oils and creams available at drugstores. Some turn to herbal oils and creams, such as extracts from geranium, lavender, eucalyptus, tea tree, and bergamot.
Others use capsaicin cream, made from hot chili peppers. A drug called Qutenza contains “pure, concentrated, synthetic capasaicin,” according to the FDA. Qutenza can be used every three months and is applied by a doctor via a patch or patches placed for an hour on the places on the skin that hurt. Before applying the patch, the doctor spreads a topical anesthetic on the area to be treated.
Ralph said many people find relief from the anesthetic lidocaine, available in low-concentration creams or patches over the counter, or by prescription in higher concentration patches.
“The lidocaine soaks through the skin and numbs the painful nerve endings,” says Ralph. Lidocaine patches are particularly helpful for people with allodynia, Ralph adds.
If topical creams and oils don’t provide sufficient relief, Ralph recommends asking your doctor about prescription medicines that may help, including some antidepressants, anti-convulsants, and opioids.
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What Are The Symptoms Of Shingles
Shingles most commonly affects one side of the body, but it can occur on one side of the face. In rare cases , the rash may be more widespread on the body and look similar to a chickenpox rash. The infection usually has 3 stages.
|Stages of shingles|
|Recovery, which takes about 24 weeks.
Sometimes pain can carry on for months to years after the rash has gone 1 in 5 people experience it for more than a year. The pain is described as burning, sharp and jabbing, or deep and aching. This is called post-herpetic neuralgia . Read more about post-herpetic neuralgia below.
Other complications from shingles infection include glaucoma, vision loss, facial weakness and hearing loss. If you experience any of these, see your GP for advice.
What Not To Do
As your shingles blisters start to scab, be sure not to:
- Touch or scratch your scabs. This can break the scabs and cause scarring. You might also introduce harmful bacteria into your skin that can cause an infection.
- Use thick ointments. Thick ointments will keep the scabs moist, which may increase the risk of infection. Try to keep your scabs dry instead.
- Wrap your scabs. Avoid bandages or dressings, which can stick to your scabs. Its best to keep them uncovered and dry.
- Wear tight clothes. Tight, restrictive clothing will rub against the scabs and further irritate your skin.
Even as your blisters start to scab, you might still develop new ones for about a week. Thats why its essential to keep protecting your skin as it heals.
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What Are The Pain Complications Of Shingles
Many sufferers have described the pain as extremely severe, and some even require narcotic pain-relief medications.
A blistering rash usually accompanies the outbreak. New blisters continue to appear for several days, and the entire outbreak can take weeks to heal. Blisters may cover the entire path of the affected nerve, or the involvement may be patchy. Involvement of the eyes during a shingles outbreak can be particularly serious, since scarring of the cornea and permanent vision loss can result.
Another debilitating complication of shingles is known as postherpetic neuralgia. In postherpetic neuralgia, the pain of shingles persists even after the rash has healed. The diagnosis is made when pain lasts for over 30 days after an outbreak. This pain can last for weeks, months, or even years. Up to 15% of people with shingles have this persistent pain, and it is not understood why the pain persists in some people, but it is likely that some type of nerve damage or inflammation occurs during the outbreak that leads to continued pain.
Treat Your Body And Mind
You can get worn down mentally when youâre in constant pain. Stress can make it seem even worse. Self-care starts with treating your rash, but donât stop there. Your mind and emotional state need to be cared for as well.
5. Stick with good habits: Your bodyâs working hard to fight the varicella-zoster virus that causes shingles. To give it the right support, you can:
- Eat nutritious food and have regular meals. Ask someone to make a run to the grocery store for fresh fruit and such if youâre not up for it.
- Try to get a good nightâs sleep and rest anytime you need to.
- Do gentle exercises, such as walking or stretching. Light activity can help take your mind off the pain. Keep it simple though, and check with your doctor if youâre trying something new.
6. Distract yourself: Sometimes, the best thing you can do is to put your focus elsewhere. Here are a few things to try:
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When Should I See My Doctor
See your doctor as soon as possible if you are experiencing any symptoms of shingles. Starting treatment with antiviral medicines within 3 days of the rash appearing should reduce the severity of symptoms and the risk of further complications, including post-herpetic neuralgia.
See your doctor straight away if you have symptoms of shingles and are experiencing the following:
- symptoms that affect your eye area
- a temperature of 38°C or higher
You should also see your doctor if you are pregnant, or have a weakened immune system due to medicine that suppresses the immune system, or a condition that weakens your immune system.
Lasting Pain After Shingles
Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. Its still not clear how it can be prevented or what the best treatment is.
Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word post-herpetic means post-herpes because the pain arises after infection by the herpes zoster virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.
The main symptom of post-herpetic neuralgia is pain in the nerves . The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.
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What Does A Mild Case Of Shingles Look Like
Not everyone with shingles will develop a blistering rash. A mild case of shingles may include a red rash without blisters. The shingles rash and blisters are distinct characteristics of the illness. Mild cases of shingles do not usually cause headaches, fever, or fatigue.
Whether mild or severe, pain is the most common symptom of shingles. Most people describe a deep burning, throbbing, or stabbing sensation. The pain usually subsides within 30 days.
Prevent Shingles Or Another Shingles Outbreak:
- A vaccine may be given to help prevent shingles. You can get the vaccine even if you already had shingles. The vaccine comes in 2 forms. A 2-dose vaccine is usually given to adults 50 years or older. A 1-dose vaccine may be given to adults 60 years or older.
- The vaccine can help prevent a future outbreak. If you do get shingles again, the vaccine can keep it from becoming severe. Ask your healthcare provider about other vaccines you may need.
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Treatment Of Pain After Shingles
Treatment for people with PHN may include:
- Nerve blocks: Local anesthetic or alcohol injected directly into the nerve affected
- Thoracic epidural injections: Local injection in the space around the spinal cord
- Antidepressant medications: Such as amitriptyline
- Membrane stabilizers: Such as gabapentin
- Capsaicinapplication: Topical cream applied to the affected area
Preventing Nerve Pain After Shingles
But if you’re worried about PHN, don’t despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: famciclovir , valacyclovir , and acyclovir . These medications need to be started within two to three days of the onset of shingles.
“If you look at the clinical trials with any of these drugs in people over 50,” says Dworkin, “they cut the rate of pain at six months in half. That’s a very significant improvement.” They are also very safe and have few side effects, he says.
But who needs the drugs? Dworkin says there’s not a clear consensus yet.
There are some obvious cases. “I think everyone would agree that someone who is over 50 and has severe symptoms should get preventative treatment,” he tells WebMD.
But for younger people or those with fewer risk factors, the course is less clear.
“Some people think that everyone who gets shingles should get preventative treatment with antiviral medicines, because the medicines are so safe and have such few side effects,” he says.
Others argue that preventative treatment should only be given to those at greater risk. The main reason for this, Dworkin says, is cost.
“A full course of treatment could cost anywhere between $100 and $160,” he says. “That can add up, and insurance companies might not want to pay if the risks are very, very low.”
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Help Is Available For Phn
Fortunately,early treatment for shingles can lower your chances of getting PHN.
For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.
Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.
However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.
How Long Does It Take For Shingles To Progress
Shingles progresses into blisters over three to five days and begins to crust over after seven to ten days. The rash is preceded by a prodromal phase lasting 48-72 hours or longer, consisting of throbbing pain and numbness in the area affecting the nerve. Once the rash blisters, it can last another three to five days before the lesions scab over.
After the lesions crust over, it may take two to four weeks to heal completely. At this time, pain may still be present. The most painful stage of shingles is when you have fluid-filled blisters. This usually occurs three to five days after the rash first appears.
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Skin Care And Itch Relief For Shingles
To relieve itching and discomfort, try:
- A cool, wet compresses on the affected skin
- Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion
- Zostrix, a cream that contains capsaicin
- Antihistamines to reduce itching
Keep your skin clean. Throw away bandages you use to cover your skin sores. Throw away or wash in hot water clothing that has contact with your skin sores. Wash your sheets and towels in hot water.
While your skin sores are still open and oozing, avoid all contact with anyone who has never had chickenpox, especially pregnant women.