Is it shingles?

Many patients describe a prodromal phase with abnormal skin sensations and pain in the affected dermatome (an area of skin served by an individual nerve root). The pain can be described as burning, stabbing, or throbbing; can be intermittent or constant, and may be so severe it interferes with sleep and quality of life. Headache, photophobia, malaise and fever (less common) may also occur as part of the prodromal phase.

Within two to three days (sometimes longer), a rash typically appears in a dermatomal distribution. The rash starts as red, raised lesions then develops into clusters of small blisters, with new blisters continuing to form over three to five days, before resolving over seven to 10 days. The blisters burst and this releases varicella zoster virus.

The rash is usually itchy and tingly and can be very painful. Unlike most other rashes, it is unilateral (either on the left or right) and does not usually cross the midline of the body, but there may occasionally be a slight spread to the other side around the skin over the spine. Healing of the affected skin occurs over two to four weeks and the damage from infection can occasionally cause scarring and permanent pigmentation.

The vast majority of cases of shingles are unlikely to be associated with severe complications. However, those involving the eye, nose or ear which relate to cranial nerve involvement, those affecting multiple dermatomes, and those with suspected bacterial superinfection need urgent ‘same day’ referral.

Immunocompromised patients, including patients on systemic corticosteroids or chemotherapy should also be referred urgently. Further details about severe complications are available at NICE CKS Shingles.