Shingles: Online Diagnosis and Treatment

Shingles (herpes zoster) is a painful, blistering rash that unexpectedly appears and can last for weeks. When your varicella-zoster immunity wanes over time, varicella zoster virus (VZV) in your spinal nerves can reactivate, causing shingles. Your risk of shingles and VZV-associated complications increases sharply after age 50.¹

An estimated 1.2 million people in the U.S. will develop shingles each year, and about one in every three U.S. adults will develop shingles at some point in their lives.^1,2

Anyone who has had chickenpox or been vaccinated against the varicella virus has the potential to get shingles.³ However, people who received the varicella vaccine have a lower risk of shingles than those who were infected with the wild-type varicella-zoster virus.⁴

About 10% to 18% of people with shingles will have postherpetic neuralgia, a persistent nerve pain that can last for months or even years.³Although shingles cannot be cured, antiviral medications can speed healing and reduce pain and complications, such as postherpetic neuralgia.

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform for shingles diagnosis and treatment is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat shingles.

Telehealth for shingles treatment makes it easy to consult with a virtual doctor and receive prescription medication to treat your shingles quickly and easily, even if you don’t have insurance. Schedule an appointment today to learn whether you have shingles and receive a personalized treatment plan to reduce pain and complications.

What Are Shingles?

Varicella is an infectious disease caused by the varicella-zoster virus. Your first or primary infection with varicella is referred to as chickenpox (varicella). Varicella is a respiratory infection that spreads throughout the body, ultimately causing a widespread vesicular rash. Most people have varicella in childhood or receive a vaccine to prevent the infection.

Once you have the chicken pox rash, the virus in the blisters is thought to infect nerve endings in the skin and travel along the nerve to the spinal cord. Once in the nerve ganglia outside the spinal cord, the virus establishes lifelong latency until it is reactivated.⁵

Since 1995, the varicella vaccine has made chickenpox infections much less common in the U.S. According to the Centers for Disease Control and Prevention, varicella incidence has declined by 97% since the vaccine became available.

What Are The Common Symptoms Of Shingles?

Shingles is a rash that develops in the distribution of a single nerve. The rash will form in a single stripe around one side of the body. Fewer than 20% of people with shingles will develop systemic symptoms.⁶

Symptoms of shingles include the following:

• Pain: pain may be intermittent, frequent, or sporadic
• Itching: pain and itching may occur together
• Tingling sensation: may precede pain and itching
• Headache
• Chills
• Upset stomach
• Light sensitivity
• Fatigue

About 10% to 18% of people develop complications from shingles, including the following:^6,7,8

• Postherpetic neuralgia: the most common complication from shingles, postherpetic pain may not resolve, commonly persisting for months and even years. Pain is described as burning or throbbing, intermittent sharp or electric shock-like, or excessive pain in response to normal stimuli like touch.
• Postherpetic itch: a persistent and uncontrollable itch that frequently results in skin damage.
• Encephalitis: varicella-zoster virus brain infection is a very rare complication of shingles and is seen almost exclusively in people who are immune compromised. Changes in mental status (delirium), headaches, stiff neck, fever, balance problems, and seizures are common symptoms.
• Stroke: this is a rare but serious zoster complication that is thought to result from viral invasion into large arteries supplying the brain.
• Herpes Zoster opthalmicus: when herpes zoster affects the ophthalmic branch of the trigeminal nerve, herpes zoster rash may surround the eye. Swelling, excessive tearing, red eye, blurred vision, pain when looking at light, and decreased vision may occur. Untreated patients may develop severe complications, including blindness and stroke.
• Peripheral motor neuropathy: muscle weakness or paralysis that can occur when the varicella-zoster virus spreads from the sensory nerve root to the motor nerve root.
• Ramsey Hunt Syndrome: when varicella-zoster virus affects the facial nerve, it can cause a painful rash affecting the ear, mouth, and throat, along with facial paralysis. Ramsey Hunt can cause permanent hearing loss if not treated promptly.

Can Shingles Be Treated Through Telehealth?

Consulting a medical professional via telehealth is a convenient way to diagnose and treat shingles. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your symptoms and call your online prescription to a local pharmacy. Online doctors who prescribe shingles treatment medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Are Some People at Increased Risk for Shingles?

Anyone who has had a varicella (chickenpox) infection or has been vaccinated against it can develop shingles at some point. Factors that may increase your risk of developing shingles include the following:⁹

• Increasing age: shingles risk rises sharply after age 50
• Immune compromise: any medical condition that reduces or alters immune function can increase shingle’s risk
• Medications: any medications that suppress immune function can increase shingles risk

Other factors associated with increased shingles risk include:⁹

• Sex: women are at higher risk than men
• Race: white individuals are at a higher risk than Black individuals
• Family history
• Autoimmune conditions: rheumatoid arthritis and systemic lupus erythematous can increase risk
• Comorbid medical conditions: HIV infection, organ transplantation, diabetes, etc.

Stress, extreme fatigue, and other infectious diseases are also thought to increase shingles risk.¹⁰

How Do You Diagnose Shingles?

Shingles is a clinical diagnosis made after taking a medical history and completing a physical exam. Shingles rash is very characteristic in that it is nearly always restricted to a single dermatome. In about 20% of cases, two adjacent dermatomes are affected. Occasionally, herpes zoster rash will cross the midline of the body, which can make diagnosis more challenging.¹¹

If the diagnosis is unclear, polymerase chain reaction (PCR) testing for the virus can be performed.

How Do You Treat Shingles?

Shingles is treated with antiviral medications. These medications speed up the healing process, decrease the severity and duration of shingles-related pain and reduce your chances of developing complications. These medications are most effective if started within 72 hours of symptom onset.¹²

Antiviral medications:

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Other medications used to treat shingles and shingles-related pain include:¹¹

• Topical lidocaine
• Capsaicin
• Antiseizure medications: gabapentin and pregabalin help control nerve pain
• Tricyclic antidepressants help control nerve pain
• Opioids: oxycodone and morphine
• Corticosteroids

How Can You Prevent Shingles?

The U.S. Food and Drug Administration approved Shingrex, a vaccine to prevent shingles, on October 23, 2017. In clinical trials, the vaccine reduced the incidence of herpes zoster by 96% when compared to placebo.^12,13

Shingrex is recommended for all people aged 50 and older, including those who have already received a Zostavax vaccine. The vaccine is administered in two doses, with the second dose given two to six months after the first dose.¹²

When Should You See a Doctor for Shingles?

If you suspect that you have shingles, see a doctor right away. Prompt diagnosis and treatment with an effective antiviral medication can help relieve pain and itching, speed your recovery and decrease your risk of complications.

If you fall into any of the following categories, prompt treatment is even more important:

• Are over age 50
• Have a condition that weakens or alters your immune function or someone close to you does
• Take medications that diminish your immune response
• Have a suspected shingles rash on your face or scalp

Telehealth for shingles treatment is the perfect option because starting treatment as early as possible is essential. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a shingles diagnosis based on your medical history and rash. Your virtual doctor can give you tips on reducing shingles pain and call in a prescription to a local pharmacy. Online doctors who treat shingles provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining a shingles treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for shingles treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your shingles treatment options.
• Treatment: After deciding on an optimal and personalized shingles treatment plan, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007 Nov;82(11):1341-9. doi: 10.4065/82.11.1341. Erratum in: Mayo Clin Proc. 2008 Feb;83(2):255. PMID: 17976353.

2. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007 Nov;82(11):1341-9. doi: 10.4065/82.11.1341. Erratum in: Mayo Clin Proc. 2008 Feb;83(2):255. PMID: 17976353.

3. Centers for Disease Control and Prevention. Shingles (Herpes Zoster). CDC.gov. Published February 3, 2022. Accessed July 22, 2023. https://www.cdc.gov/shingles/index.html

4. Centers for Disease Control and Prevention. Clinical Overview. CDC.gov. Published May 10, 2023. Accessed July 22, 2023. https://www.cdc.gov/shingles/hcp/clinical-overview.html

5. Kennedy PG, Grinfeld E, Gow JW. Latent varicella-zoster virus is located predominantly in neurons in human trigeminal ganglia. Proc Natl Acad Sci U S A. 1998 Apr 14;95(8):4658-62. doi: 10.1073/pnas.95.8.4658. PMID: 9539794; PMCID: PMC22546.

6. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007 Jan 1;44 Suppl 1:S1-26. doi: 10.1086/510206. PMID: 17143845.

7. Lewis K, Palileo B, Pophal C et al. Herpes Zoster Ophthalmicus. American Academy of Ophthalmology. Published January 1, 2020. Accessed July 22, 2023. https://www.aao.org/eyenet/article/herpes-zoster-ophthalmicus-pearls

8. Gupta NM, Parikh MP, Panginikkod S, Gopalakrishnan V. Ramsay Hunt syndrome. QJM. 2016;109(10):693. doi:10.1093/qjmed/hcw113

9. Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Open Forum Infect Dis. 2017;4(Suppl 1):S313–S314. doi:10.1093/ofid/ofx163.733

10. Harpaz R, Leung JW, Brown CJ, Zhou FJ. Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?. Clin Infect Dis. 2015;60(5):781-785. doi:10.1093/cid/ciu889

11. Gnann JW, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002;347(5):340-346.

12. Saguil A, Kane S, Mercado M, Lauters R. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician. 2017;96(10):656-663

13. Lal H, Cunningham AL, Godeaux O, et al.; ZOE-50 Study Group. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015;372(22):2087-2096.