During round one with varicella-zoster, the entire body is affected with fever and the small lesions we call chickenpox. In round two, with shingles, only specific nerves are involved, so the symptoms are limited to certain sections of the body. Often, the first symptom is severe pain in a narrow band of the body such as the chest, groin, face, one eye or the outer side of one leg. This may be accompanied by nausea, vomiting and general illness. After a few days, a linear, raised rash will develop — the classic shingles rash.
Making the Diagnosis
Because the pain from shingles starts before the rash appears, the diagnosis can be very difficult to make. I had a patient who developed severe pain in the left side of his chest and was taken to the hospital to rule out a heart attack. The rash erupted two days later. Another patient experienced excruciating burning in her vagina for two days, which worsened when walking, before developing a rash on her abdomen and back.
The main way to identify shingles is to look at how the rash is distributed. Typically, the rash does not cross the midline of the body, only affecting one side of the face, chest or back. The rash consists of fluid-filled blisters or pustules, which may crop up in one cluster or in patches on the skin. Still, although there are distinguishing features to the shingles rash, it can be easily confused with other types of skin inflammation.
Another unfortunately common sign of shingles is ophthalmic zoster, painful lesions that affect the eye and can impair vision. When shingles affects the ear, it is called Ramsay-Hunt syndrome and can cause facial paralysis, hearing loss and vertigo. When the diagnosis is not quite clear, a doctor can take a swab of a fresh lesion and send it to a lab for specialized testing.
