The early symptoms of shingles such as pain in the back and shoulder area are often misinterpreted. And the rash can also look like an insect bite at first.
The signs of shingles, medically herpes zoster, are not always clear. Especially before the most important symptom – the rash – occurs, slight to massive pain in the affected area is possible, and hardly anyone thinks of herpes zoster.
They arise when the chickenpox viruses (varicella) have been reactivated and migrate from the nerve nodes in which they were inactive along the relevant nerves to the surface of the skin.
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Back pain as bad as a herniated disc
It is therefore a nerve pain that, depending on the area affected, extends from the back to the chest, into the shoulder or into the stomach. The pain can be very different and sometimes very severe. Those affected then sometimes think they have a disc or shoulder problem and go to the orthopedic surgeon.
The typical rash of shingles does not appear until around two days after the pain starts. In connection with the pain, the suspicion that it is not a problem in the musculoskeletal system, the kidneys or the bile, but rather shingles.
Nevertheless, doctors advise, if patients experience severe pain, they should not hesitate to go to a doctor – depending on the location, an orthopaedic surgeon or internist.
Herpes simplex, insect bite or shingles? These are the differences
But this pain does not always occur. Most often, the rash is the only symptom. Especially if it also occurs in areas that are generally less known for shingles – for example on the eyelid, ear, buttocks – the skin appearance is sometimes not even recognized correctly by doctors.
The danger of confusing zoster with insect bites, however, only exists in a few cases, often only on the first day. In the case of zoster, however, the agonizing itching typical of insect bites is missing. In addition, the zoster rash changes within hours, and bulging blisters form. And insect bites are not accompanied by nerve pain, which is very common with zoster.
It is not that easy to distinguish between shingles and herpes simplex.
“There are variants of zoster where you only see individual blisters, for example in the face it can be mistaken for herpes simplex,” explains the expert.
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These viruses, which among other things lead to cold sores, belong, like the varicella viruses, to the family of herpes viruses.
Rapid treatment for shingles is important
The cause of skin symptoms, such as red spots on the skin and blisters that form on them, is therefore not only difficult for laypeople to recognize. But especially in the case of shingles, the treatment should be carried out within the first 72 hours after the appearance of the blisters, otherwise the medication will no longer work optimally. But many hesitate to go straight to a dermatologist about a little rash.
Three warning signs of a rash that speak for shingles
In this context, experts recommend going to a doctor if you notice one of the following warning signals:
1. In addition to the rash, feeling pain there and/or around neighbouring regions.
2. The rash with blisters and pain is one-sided, affects one half of the body, so it usually does not cross the centre line of the face, back or chest.
3. The rash (and pain) comes on quickly and develops within one to three days.
The other sign of shingles that may appear before a rash can be a tingling or painful feeling in an area of skin, or a headache and feeling generally unwell or can include fever or chills.
A few days later, a rash will appear somewhere on your body.
While it normally occurs on your chest and tummy, it could also appear on your face, eyes and genitals.
If you do get a rash on one side of your face, you need to see a doctor immediately.
The rash is normally raised and looks like red blotches.
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It tends to appear on only one side of your body, so if you have it on both sides it probably isn’t shingles.
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