Misdiagnosed as shingles. Shingles Misdiagnosis: Symptoms, Causes, and Look-alike Conditions

25.08.202329.06.2023 by alexxlab

What are the key symptoms of shingles. How can shingles be differentiated from other skin conditions. What causes shingles to develop. When should you seek medical attention for a suspicious rash.

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Understanding Shingles: A Comprehensive Overview

Shingles, medically known as herpes zoster, is a viral infection that manifests as a painful, blistering rash. This condition affects approximately 1 million people annually in the United States, typically appearing on one side of the body or face. Shingles occurs when the varicella-zoster virus, which causes chickenpox, reactivates after lying dormant in the nervous system for years.

The primary symptoms of shingles include:

Pain
Itching
Tingling sensation
A painful rash with blistering sores
Fever and chills
Headache
Gastrointestinal disturbances

While shingles is generally not life-threatening, it can cause severe discomfort and lead to long-term complications such as postherpetic neuralgia (PHN). This condition, characterized by persistent pain lasting 90 days or more after the rash has healed, affects 10-18% of shingles patients, with the risk increasing significantly with age.

The Progression and Presentation of Shingles

How does shingles typically develop? The infection usually follows a distinct pattern:

Initial symptoms: Pain, itching, and tingling in a specific area
Rash development: A painful, blistering rash appears, often in a stripe-like pattern on one side of the trunk
Blister formation: Blisters form and fill with fluid over 3-5 days
Crusting and healing: Blisters rupture, form sores, then crust over and heal within 2-4 weeks

In some cases, shingles may present atypically. Disseminated shingles, characterized by a widespread rash, can occur in individuals with weakened immune systems. Additionally, the virus may affect internal organs such as the lungs, liver, brain, or blood vessels, potentially leading to life-threatening complications.

Potential Complications of Shingles

What are the possible complications of shingles? While most cases resolve without significant issues, some individuals may experience:

Vision loss
Pneumonia
Hearing problems
Encephalitis (brain inflammation)
Partial facial paralysis
Polyneuritis (damage to multiple peripheral nerves)

Conditions Commonly Mistaken for Shingles

Given the variability in shingles presentation, it’s not uncommon for the condition to be misdiagnosed. Several skin conditions can mimic the symptoms of shingles, leading to potential confusion:

Cellulitis
Chickenpox
Herpes simplex
Impetigo
Folliculitis
Irritant contact dermatitis
Insect bites
Mucosal candidiasis (oral thrush)

How can healthcare providers differentiate shingles from these conditions? While a thorough physical examination and medical history are often sufficient for diagnosis, doctors may sometimes need to take samples of skin, mucus, or blood for laboratory testing to confirm the presence of the varicella-zoster virus.

The Underlying Cause of Shingles

What causes shingles to develop? The root cause of shingles is the reactivation of the varicella-zoster virus, which initially causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in their nervous system. Years or even decades later, the virus can reactivate, leading to shingles.

The exact trigger for this reactivation isn’t always clear, but factors that may contribute include:

Weakened immune system
Stress
Advanced age
Certain medications
Chronic diseases

Transmission and Contagiousness of Shingles

Is shingles contagious? While you can’t “catch” shingles from someone else, the varicella-zoster virus can be transmitted from a person with active shingles to someone who has never had chickenpox or been vaccinated against it. This transmission occurs through direct contact with the fluid from shingles blisters.

When is shingles most contagious? The virus can spread from the time the blisters appear until they have fully crusted over. During this period, individuals with shingles should avoid contact with:

Pregnant women who have never had chickenpox or the vaccine
Premature or low birth weight infants
People with weakened immune systems

Prevention and Vaccination Against Shingles

How can you prevent shingles? The most effective method of prevention is vaccination. The Centers for Disease Control and Prevention (CDC) recommends the Shingrix vaccine, which can provide up to 97% protection against shingles, depending on age and immune status.

Who should get the shingles vaccine? The Department of Health and Human Services advises vaccination for:

Adults aged 50 years or older
Individuals 19 or older with weakened immune systems due to health conditions or treatments
People 19 or older at risk of a weakened immune system due to upcoming treatments

The vaccine is recommended even for those who have previously had shingles, been vaccinated with the older Zostavax vaccine, or are unsure if they’ve had chickenpox. It’s administered in two doses, with the second dose given 2-6 months after the first.

Diagnosing Shingles: When to Seek Medical Attention

When should you consult a healthcare provider about a possible case of shingles? It’s crucial to seek medical attention promptly if you experience:

A painful, blistering rash, especially if it appears in a band on one side of your body
Burning, tingling, or numbness in a specific area before a rash appears
Symptoms affecting your face, particularly near your eyes
Fever, chills, or other flu-like symptoms accompanying a rash

Early diagnosis and treatment can help reduce the severity of symptoms and lower the risk of complications. Healthcare providers can typically diagnose shingles based on the characteristic appearance of the rash and associated symptoms. In some cases, they may perform additional tests to confirm the diagnosis or rule out other conditions.

Treatment Options for Shingles

What treatments are available for shingles? While there’s no cure for shingles, several treatment options can help manage symptoms and potentially shorten the duration of the outbreak:

Antiviral Medications

Antiviral drugs are the cornerstone of shingles treatment. These medications work by stopping the virus from multiplying, which can:

Speed up healing of the rash
Reduce the severity and duration of pain
Decrease the risk of complications

Commonly prescribed antiviral medications for shingles include:

Acyclovir
Valacyclovir
Famciclovir

These medications are most effective when started within 72 hours of the rash’s appearance.

Pain Management

Managing pain is a crucial aspect of shingles treatment. Options may include:

Over-the-counter pain relievers (e.g., acetaminophen, ibuprofen)
Topical numbing agents (e.g., lidocaine patches)
Prescription pain medications for severe cases
Nerve blocks in some instances

Topical Treatments

Various topical treatments can help soothe the skin and promote healing:

Calamine lotion to relieve itching
Cool compresses to reduce inflammation
Colloidal oatmeal baths to soothe irritated skin

Management of Postherpetic Neuralgia

For individuals who develop postherpetic neuralgia, additional treatments may be necessary:

Anticonvulsant medications (e.g., gabapentin, pregabalin)
Tricyclic antidepressants
Topical capsaicin cream
Transcutaneous electrical nerve stimulation (TENS)

How long does shingles treatment typically last? The duration of treatment can vary depending on the severity of the outbreak and the presence of complications. Antiviral medications are usually prescribed for 7-10 days, while pain management may continue for several weeks or months in cases of postherpetic neuralgia.

Living with Shingles: Coping Strategies and Lifestyle Adjustments

How can individuals cope with the discomfort and lifestyle changes associated with shingles? Here are some strategies to manage symptoms and promote recovery:

Self-Care Measures

Keep the rash clean and dry to prevent bacterial infections
Wear loose-fitting, natural fiber clothing to minimize irritation
Apply cool, wet compresses to the rash to relieve pain and itching
Take lukewarm baths with colloidal oatmeal or baking soda to soothe the skin
Use calamine lotion or other soothing gels to reduce itching

Stress Management

Stress can exacerbate shingles symptoms and potentially prolong recovery. Consider incorporating stress-reduction techniques such as:

Meditation or mindfulness practices
Deep breathing exercises
Gentle yoga or tai chi
Progressive muscle relaxation

Dietary Considerations

While there’s no specific diet for shingles, maintaining a balanced, nutrient-rich diet can support overall health and immune function. Consider including:

Foods rich in vitamins A, B12, C, and E
Sources of lysine, such as fish, chicken, and eggs
Plenty of water to stay hydrated

Activity Modifications

Depending on the location and severity of the shingles outbreak, you may need to modify your usual activities:

Avoid strenuous exercise during the acute phase of the illness
Take breaks and rest when needed
Use assistive devices if shingles affects your mobility

Social Considerations

To prevent transmission of the virus to susceptible individuals:

Avoid close contact with people who haven’t had chickenpox or the vaccine
Keep the rash covered when around others
Wash hands frequently, especially after touching the affected area

Long-Term Outlook and Follow-Up Care for Shingles Patients

What can individuals expect in terms of long-term outcomes after a shingles outbreak? For most people, shingles is a self-limiting condition that resolves within a few weeks. However, some may experience longer-term effects:

Postherpetic Neuralgia (PHN)

As mentioned earlier, PHN is the most common complication of shingles. It can persist for months or even years after the rash has healed. Regular follow-up with healthcare providers is crucial for managing this condition effectively.

Recurrence Risk

While it’s possible to develop shingles more than once, it’s relatively uncommon. Studies suggest that the recurrence rate is around 5% within 8 years of the initial outbreak. Vaccination can help reduce this risk.

Psychological Impact

The pain and discomfort associated with shingles can take a toll on mental health. Some individuals may experience:

Anxiety
Depression
Sleep disturbances
Reduced quality of life

Mental health support may be beneficial for those struggling with the psychological effects of shingles.

Follow-Up Care

After the acute phase of shingles, follow-up care may involve:

Regular check-ups to monitor for complications
Adjustment of pain management strategies as needed
Referral to specialists (e.g., neurologists, pain management experts) if complications arise
Discussion of vaccination to prevent future outbreaks

By understanding the potential long-term implications of shingles and maintaining open communication with healthcare providers, individuals can better navigate the recovery process and manage any lasting effects of the condition.

Is it shingles? Symptoms vs. other conditions and causes

Shingles, also called herpes zoster, is an infection that causes a painful, blistering rash, often on one side of the body or face. There may also be ongoing neurologic pain.

Shingles happens when the chickenpox virus reactivates, often many years later. It affects about 1 million people each year in the United States. There may also be a fever, chills, headache, gastrointestinal disturbances, and headache.

In most cases, shingles is not a life threatening condition, but it can cause severe pain, and the effects can linger for months or years as postherpetic neuralgia.

Vaccinations against the chickenpox virus and the shingles virus can help prevent shingles.

The first symptoms of shingles are usually:

pain
itching
tingling

Next, the following may start to appear:

a painful rash of blistering sores, which appears as a single stripe around one side of the trunk
a rash around the eye
fever and chills
headache
gastrointestinal symptoms
a rash or ulcers in the mouth, known as oral shingles

The rash from shingles tends to develop in a hallmark pattern, usually on the trunk. People sometimes call it a “shingles band” due to the striped pattern. They appear over 3–5 days.

Pain occurs because the virus causes inflammation in the nerves.

Over the next 7–10 days, the blisters often rupture, form sores, and then crust over and heal. The rash usually disappears in 2–4 weeks.

Disseminated shingles involves a widespread rash. It can affect people with a weakened immune system.

In some people, the rash heals, but the pain continues for 4 weeks or longer. In some cases, there may be severe pain lasting 90 days or more, known as postherpetic neuralgia (PHN).

According to the Centers for Disease Control and Prevention (CDC), PHN affects 10–18% of people who have had shingles. It rarely affects those under 40 years, but 13% of individuals aged 50 years or over will develop PHN after shingles. By the age of 70, this figure rises to around 75%.

In some cases, shingles can lead to:

vision loss
pneumonia
hearing loss
encephalitis, an inflammation of the brain
partial facial paralysis
polyneuritis, where multiple peripheral nerves become damaged

In some cases, the virus affects the internal organs, such as the lungs, liver, brain, spinal cord, or blood vessels. In this case, it can become life threatening. Having a weakened immune system may increase the risk of internal involvement.

What is internal shingles?

The symptoms of shingles can sometimes resemble those of other conditions, such as:

cellulitis
chickenpox
herpes simplex
impetigo
folliculitis
irritant contact dermatitis
insect bites
mucosal candidiasis, or oral thrush

The best way to work out if a rash is shingles is to speak with a doctor. In most cases, a doctor can make a diagnosis according to a person’s medical history, a physical exam, and symptoms. However, they may take a sample of skin, mucus, or blood for testing to confirm the diagnosis.

Anyone who suspects they have shingles needs to seek medical advice. Treatment can help speed recovery and reduce the risk of complications.

What do skin infections look like?

A virus called varicella zoster causes shingles. It also causes chickenpox, which used to be a common childhood illness before health experts developed a vaccine for it.

Once a person has a chickenpox infection, the virus remains in their nervous system, even after they recover. Although the virus stays in the body, doctors consider it latent, meaning it is inactive and does not cause any symptoms.

At some point, the virus can reactivate and cause shingles. The reason the virus reactivates is not entirely clear — it may become active again if a person’s immune system becomes weakened or stressed.

What treatment options are there for shingles?

A person cannot get shingles from another individual, but they can get chickenpox from someone who has shingles if they do not have immunity to chickenpox.

Transmission can occur through contact with the fluid that comes from the blisters.

When is shingles contagious?

Vaccination

According to the CDC, the shingles vaccine (Shingrix) is safe and can provide up to 97% protection against shingles, depending on the person’s age and the status of their immune system.

The Department of Health and Human Services advises everyone to have the shingles vaccine if they are:

are aged 50 years or older
are aged 19 or older and have a weakened immune system due to a health condition or treatment, such as chemotherapy
are aged 19 or older and are at risk of a weakened immune system because of upcoming treatments

People should have the vaccine even if they:

have already had shingles
have previously been vaccinated with Zostavax, a vaccine that is no longer in use
are not sure if they have had chickenpox

The vaccine comes in two doses, the second being 2–6 months after the first.

Here are some questions people often ask about shingles symptoms.

What are the first signs of shingles?

Early symptoms include a feeling of pain, burning, and itching in one area of the skin. After this, a rash appears, and fluid-filled blisters form. The rash is painful because the virus causes infection in the nerve cells.

What are the triggers for shingles?

Possible triggers for shingles include:

emotional stress
the use of immunosuppressant medications
having a health condition that affects immunity

Will shingles go away without treatment?

There is currently no cure for shingles, but the rash usually clears up in 2–4 weeks. However, treatment can help manage it. If a person takes antiviral medication soon after the rash appears, it may shorten the duration of the infection and reduce the severity of symptoms.

Over-the-counter pain relief, wet compresses, calamine lotion, and lukewarm baths with colloidal oatmeal may help manage discomfort.

What are some natural treatments for shingles?

How long does shingles last?

The first symptoms of shingles are often pain, tingling, itching, and then a rash. The rash often forms a band around one side of the trunk. In time, blisters can form. These usually heal within 2–4 weeks, but some people have ongoing pain known as postherpetic neuralgia.

The rash can also affect the eyes and mouth, with a risk of vision loss.

Vaccination can help prevent shingles. Health experts recommend it for people aged 50 years and above and those aged 19 and over who have or are at risk of having a weakened immune system.

Is it shingles? Symptoms vs. other conditions and causes

Shingles, also called herpes zoster, is an infection that causes a painful, blistering rash, often on one side of the body or face. There may also be ongoing neurologic pain.

In most cases, shingles is not a life threatening condition, but it can cause severe pain, and the effects can linger for months or years as postherpetic neuralgia.

Vaccinations against the chickenpox virus and the shingles virus can help prevent shingles.

The first symptoms of shingles are usually:

pain
itching
tingling

Next, the following may start to appear:

a painful rash of blistering sores, which appears as a single stripe around one side of the trunk
a rash around the eye
fever and chills
headache
gastrointestinal symptoms
a rash or ulcers in the mouth, known as oral shingles

The rash from shingles tends to develop in a hallmark pattern, usually on the trunk. People sometimes call it a “shingles band” due to the striped pattern. They appear over 3–5 days.

Pain occurs because the virus causes inflammation in the nerves.

Over the next 7–10 days, the blisters often rupture, form sores, and then crust over and heal. The rash usually disappears in 2–4 weeks.

Disseminated shingles involves a widespread rash. It can affect people with a weakened immune system.

In some people, the rash heals, but the pain continues for 4 weeks or longer. In some cases, there may be severe pain lasting 90 days or more, known as postherpetic neuralgia (PHN).

In some cases, shingles can lead to:

vision loss
pneumonia
hearing loss
encephalitis, an inflammation of the brain
partial facial paralysis
polyneuritis, where multiple peripheral nerves become damaged

What is internal shingles?

The symptoms of shingles can sometimes resemble those of other conditions, such as:

cellulitis
chickenpox
herpes simplex
impetigo
folliculitis
irritant contact dermatitis
insect bites
mucosal candidiasis, or oral thrush

Anyone who suspects they have shingles needs to seek medical advice. Treatment can help speed recovery and reduce the risk of complications.

What do skin infections look like?

A virus called varicella zoster causes shingles. It also causes chickenpox, which used to be a common childhood illness before health experts developed a vaccine for it.

What treatment options are there for shingles?

A person cannot get shingles from another individual, but they can get chickenpox from someone who has shingles if they do not have immunity to chickenpox.

Transmission can occur through contact with the fluid that comes from the blisters.

When is shingles contagious?

Vaccination

According to the CDC, the shingles vaccine (Shingrix) is safe and can provide up to 97% protection against shingles, depending on the person’s age and the status of their immune system.

The Department of Health and Human Services advises everyone to have the shingles vaccine if they are:

are aged 50 years or older
are aged 19 or older and have a weakened immune system due to a health condition or treatment, such as chemotherapy
are aged 19 or older and are at risk of a weakened immune system because of upcoming treatments

People should have the vaccine even if they:

have already had shingles
have previously been vaccinated with Zostavax, a vaccine that is no longer in use
are not sure if they have had chickenpox

The vaccine comes in two doses, the second being 2–6 months after the first.

Here are some questions people often ask about shingles symptoms.

What are the first signs of shingles?

What are the triggers for shingles?

Possible triggers for shingles include:

emotional stress
the use of immunosuppressant medications
having a health condition that affects immunity

Will shingles go away without treatment?

Over-the-counter pain relief, wet compresses, calamine lotion, and lukewarm baths with colloidal oatmeal may help manage discomfort.

What are some natural treatments for shingles?

How long does shingles last?

The rash can also affect the eyes and mouth, with a risk of vision loss.

Vaccination can help prevent shingles. Health experts recommend it for people aged 50 years and above and those aged 19 and over who have or are at risk of having a weakened immune system.

How to diagnose shingles – advice from a dermatologist

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How to diagnose shingles: Shingles is an infection that causes a painful skin rash. Primary diagnosis of shingles will require a consultation with a dermatologist.

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Shingles symptoms

The first signs of shingles may be:

tingling or soreness in the skin;
headache or general malaise;
and only a few days later the rash appears.

Shingles usually first appears on the chest and abdomen, but it can develop anywhere on the body, including the face, eyes, and genitals. The rash looks like red spots on the skin on only one side of the body (a rash on both sides of the body is unlikely to be herpes zoster – this is an important sign that helps to differentiate the disease from other conditions). Later, the spots turn into itchy blisters that ooze fluid, and after a few days the blisters dry out and crust over. A rash can also appear around the eye, making it painful and red, and can even affect vision or hearing and make it difficult to move one side of the face. The rash can take up to 4 weeks to heal. The skin may remain sore for several weeks after the crusts have disappeared.

Is shingles contagious?

A person cannot pass shingles to other people. But people who haven’t had chickenpox before can catch it from a sick person, because shingles is caused by the varicella-zoster virus. Therefore, in order to prevent the spread of the disease, the patient should avoid contact with:

pregnant women who have not previously had chickenpox;
patients with a weakened immune system;
infants less than 1 month old.

Also, do not go to work or school if fluid is still coming out of the rash, or until the rash is dry. A person cannot get shingles from chicken pox.

Shingles and pregnancy

If a pregnant woman develops shingles, it does not pose a risk to her pregnancy and unborn child. But you should still see a dermatologist, as she may need antiviral treatment.

Herpes zoster vaccine

Herpes zoster vaccine is available free of charge for people over 70 years of age. This helps reduce the risk of developing the disease. If a patient develops shingles after vaccination, the symptoms may be much milder.

Herpes zoster treatment

The patient may need medication to help speed recovery and avoid longer problems. Therapy works best if started within 3 days of the first rash. The patient can make independent attempts to alleviate his condition:

take paracetamol to relieve pain;
keep the rash clean and dry to reduce the risk of infection;
wear loose clothing;
use a cool compress (a bag of frozen vegetables wrapped in a towel or damp cloth) several times a day;
prevent dressings or patches from sticking to the rash;
do not use antibiotic cream – this will slow down healing.

Author: Makarova Ksenia Nikolaevna

Specialization: Dermatologist

Where does the appointment: Mirramed Aesthetic Medicine Center

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Literature:

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Polymorphic light eruption

Polymorphic light rash is a fairly common skin rash caused by exposure to sunlight or artificial ultraviolet (UV) light.