Shingles: Diagnosis and treatment
How do dermatologists diagnose shingles?
To diagnose shingles, a dermatologist will look at the skin and ask some questions.
If there is any doubt, the dermatologist may scrape a blister to get a sample. This sample will be examined under a microscope. Also, the dermatologist may send the fluid from a blister to a laboratory for testing.
How do dermatologists treat shingles?
Without treatment, the rash clears in a few weeks. Dermatologists, however, strongly recommend treatment. Without it, many people get pain, numbness, itching, and tingling that can last for months — or years.
It is best to get treatment immediately. Treatment can include:
- Pain relievers to help ease the pain: The pain can be very bad, and prescription painkillers may be necessary.
- Anti-viral medicine: This medicine may be prescribed when a doctor diagnoses shingles within 72 hours of the rash first appearing. The earlier anti-viral treatment is started, the better it works. Anti-viral medicines include famciclovir, valacyclovir, and acyclovir. These can lessen the pain and the amount of time the pain lasts.
- Nerve blocks: Given for intense pain, these injections (shots) contain a numbing anesthetic and sometimes a corticosteroid.
- Corticosteroids: To lower swelling and pain, some patients may get corticosteroid pills with their anti-viral medicine. This treatment is not common because it can make the rash spread.
Treatments for pain after the rash clears: Certain anti-depressants, pain relievers, anesthetic creams and patches, and anti-seizure medicines can help.
Ask your dermatologist about possible side effects (health problems that can result from the medicines).
Patients with shingles rarely need a hospital stay. But shingles can cause serious problems such as:
- Post-herpetic neuralgia (post-her-PET-ic noo-RAL-jah):
This is the most common problem. It can cause pain, numbness, itching, and tingling. It can last for months — or even years. People who get this also may have fatigue, little appetite, and trouble sleeping. Sometimes they experience intense pain from something as harmless as a light touch. People over age 60 are most likely to have this complication.
- Eye problems: Shingles that involve the eye are called ocular shingles or herpes zoster ophthalmicus. Signs and symptoms of shingles in the eye are blisters around the eye or on the eyelid, swelling and redness of the eye or eyelid, and eye pain. Some people become sensitive to light. After a bout with shingles that involves the eye, a person can have blurred vision or feel that something is in the eye.
If blisters appear on the tip of the nose, it may be a warning of possible eye problems. Anyone who gets blisters on the nose should see a doctor immediately. Without treatment, permanent eye damage can result. Glaucoma, scarring, and even blindness are possible. People who have shingles in the eye also may have a higher risk for having a stroke.
- Bacterial infection: The blisters can become infected, which can slow healing. Lasting pain and redness warn of an infection. If either occurs, see your dermatologist. You may need antibiotic treatment. An infection can lead to scars without prompt treatment.
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.