Podcast: How Can I Tell If I Have Shingles

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

If you had chicken pox as a kid, then there’s a chance you might get shingles as an adult. The virus can come on suddenly and lead to painful symptoms. Why does shingles happen and how can you treat it?

This week, we get the answers from Dr. Victoria Perez, a dermatologist at Columbia and NewYork-Presbyterian The One, a new center for advanced care in Westchester. She walks us through how to know if it’s indeed shingles, various treatments, and shares tips for prevention.

Courtney: Dr. Perez, thank you so much for coming on the show.

Dr. Victoria Perez: Hello there, Courtney, thank you for having me.

Courtney: So we’re here today to talk about shingles, which I know can be a painful and annoying virus. Can you give us a basic overview of what exactly shingles is? 

Dr. Victoria Perez: So shingles is also what we call herpes zoster. It’s reactivation of a latent infection with the varicella zoster virus. And so usually after a primary infection like chickenpox, the virus can lay dormant in our dorsal root ganglia, so kind of in the nerves, if you will, for life. And this reactivation can sometimes be triggered later in life by a variety of factors, sometimes by sickness, sometimes by medications, sometimes by stress. Oftentimes we’re not sure, but it can be reactivated.

Courtney: What signs tell you that a patient is having a shingles outbreak?

Dr. Victoria Perez: Oftentimes what will happen is that skin shingles can begin with a one-to-three day early symptoms and signs of burning pain or tingling. And that can be a sign that something is starting to brew.

The other big clue that dermatologists look for is what’s called a dermatomal distribution. And so what you’ll get is you’ll get a few days of burning pain or stinging to an area on your skin, usually localized, and that’s followed by an eruption of usually red bumps and fluid-filled blisters in that same distribution. That is the textbook story, not all shingles read the textbook and they will often decide what they wanna look like. And so I think every dermatologist has a story of someone who came in with something that did not look like the classic shingles. There is a test, a little swab that we can do to test.

Some people may say there was no burning. Some people will say, there was nothing before I just noticed this area around my shoulder, or I notice this around my, in a certain place on my eye. They can be grouped together, they can be sparse, they can be spread apart. The blisters themselves can be fluid filled. Sometimes they can be bloody. The lesions themselves will typically crust over and get better after about a week or two. And then sometimes you can even see some scarring.

Courtney: Can you clarify a little bit more the connection to chickenpox? Like if you had chickenpox as a child, does that mean maybe you won’t get shingles when you’re older or maybe you will? ‘Cause I know you mentioned that the virus can reactivate.

Dr. Victoria Perez: Yeah, it lays dormant so you can get it. Chicken pox is a little bit different. There’s chickenpox in terms of the varicella. So you’re not gonna get the varicella known as chicken pox ’cause it’s a self-limited viral infection. But you can get shingles afterward.

Courtney: How soon should someone see the doctor if they suspect they might have shingles? And what kind of doctor would that be?

Dr. Victoria Perez: You can go to your dermatologist, you can also go to your primary care doctor. I think, you know, the type of treatment is, the sooner, the better because if you can get the medication in the first 72 hours even up to a week after the symptoms start, you can shorten the length and severity of your shingles outbreak. Even folks who have like a burning, I think that’s totally appropriate to seek medical attention.

Courtney: So once you’ve made the diagnosis of shingles, either by physical examination or testing, what are the next steps as far as treatment and therapy?

Dr. Victoria Perez: Antiviral therapy that you can take orally to help with an acute episode that can help decrease the likelihood of developing any type of secondary complication, because sometimes that burning and stinging can last even after the rash is gone.

Valtrex is the antiviral medication, is very safe and well tolerated. Not every shingles is swabbed and tested in terms of, you know, proving that it’s shingles. And so even if there’s a high, what we call clinical suspicion, so if the patient comes in saying, oh, it started off with like, it’s in this one area and it started off as burning and then I got these blisters. If it quacks like a duck sounds like a duck, walks like a duck, you may wanna say, hey, let’s get you started on this antiviral therapy so that we can try to shorten this course and help prevent you from having any secondary side effects as well.

Courtney: So you mentioned an antiviral therapy. Is there anything else that can be done for shingles, whether it’s through a provider or things you can do at home?

Dr. Victoria Perez: I would say it’s best to go to provider for therapy. If there’s breakdown in the skin, you can get secondarily super infected. So that would be even more reason to go to a provider. There is also more guidance when you go to a provider in terms of, you know, how long you should be on a medication, depending on your health background too, if you’re taking other medications or if you have other health issues that may affect your immune system, it’s even more important because you would wanna get treatment for that and that can be variable depending on your own health history. There’s not a lot you can do at home for shingles on your own, so it’s best to seek care. 

Courtney: Is there anything that would be prescribed other than the antiviral medicine? 

Dr. Victoria Perez: If there’s suspicion for an overlying super infection, you may get a topical anti-bacterial ointment. Sometimes if there’s related pain or tenderness, you know, some patients will take over the counter NSAID type of medications. It’s important that patients know that if they have active blisters that they can spread the infection. So that’s why it’s important to see a healthcare provider, but also cover any spots that they have. Things that keep dermatologists up at night is if you have an outbreak on the face, might be close to the eye, and so then you wanna make sure that it doesn’t involve any other parts other than the skin. 

Courtney: What are the particular dangers of an outbreak on the face or eye area? 

Dr. Victoria Perez: Basically what we try to make sure is that we don’t have any involvement of the eye nerves. That can be something that you would need like an ophthalmologist for. We say it’s respects all these, again, you know, boundaries and dermatomes and things, but there is a version that’s disseminated, which is, lots of blisters outside of the primary area, but typically that happens more in an immunocompromised patient population that often will need not just oral medication, but sometimes IV medication. And so those are the types of things that, you know, require acute care in like a hospital setting. But those are more on the rare side.

Courtney: Who is most at risk for shingles?

Dr. Victoria Perez: I would say older folks. Thinking about the appropriate history and kind of appearance. Older folks tend to have other kind of comorbidities or things in their health that make them more prone to infection or some of these triggers, more commonly, but that’s just more anecdotal. 

Courtney: And so should people get the shingles vaccine if they’re eligible?

Dr. Victoria Perez: I would strongly suggest or advise to prevent outbreak, to prevent spreading, when you’re eligible, I would advise my patients to be vaccinated.

Courtney: And what can we do to minimize the risks of catching shingles?

Dr. Victoria Perez: Thinking about the signs early and you know, if you’re having any burning pain, reaching out earlier. I mean, you can do everything you can in terms of preventing infections in your own self by, you know, practicing good hygiene, getting the vaccine. Those are all good ways to stay healthy. 

Oftentimes, patients will ask me, did I do this to myself, and the answer’s no. This is something that you can’t really prevent. But I would say that doing what you can do, like getting the vaccine would be helpful. And seeking the care of a physician or dermatologist when you need that expertise and you need that help and not being afraid to ask for it.

Courtney: Thank you so much Dr. Perez. I really appreciate you sharing all this about shingles and giving this insight.

Dr. Victoria Perez: Thank you so much for having me. The pleasure’s all mine.

Courtney: Our many thanks to Dr. Victoria Perez. I’m Courtney Allison.

Health Matters is a production of NewYork-Presbyterian. 

The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about the care we provide at NewYork-Presbyterian The One, a new center for advanced care in Westchester, and how to make an appointment check out the show notes.

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