Exams and Tests

Although the earliest appearance of shingles symptoms are sometimes confused with hives (raised areas of itchy skin) or scabies (skin infection by scabies mite), the classic pain and blistering in a band on one side of the body may be all that is necessary for a doctor to clinically diagnose herpes zoster. This is the most frequent way shingles is diagnosed. The rash may extend outside of this band or infrequently to the other side of the body. Rarely, there may be pain in a band without a rash.

• Your doctor may decide to do tests to confirm that you have shingles. However, these tests are not always necessary.



• A Tzanck smear, which is less commonly performed now that newer techniques are available, involves opening a blister and putting fluid and skin cells from it on a slide. After using a special stain, the slide is examined under the microscope for characteristic viral changes in the cells. This method is unable to distinguish between VZV and herpes simplex virus (HSV), however. VZV causes shingles and chickenpox. HSV causes herpes simplex (sometimes referred to as cold sores or genital herpes).



• Viral cultures or special antibody tests, such as DFA (direct fluorescent antibody), of the blister may reveal varicella-zoster virus. DFA results are often available within hours. This test differentiates between VZV and HSV. Viral cultures may take up to two weeks or more to yield results.



• Skin biopsy, taking a piece of skin rash and looking at it under the microscope, is another possible way to diagnose herpes zoster. A culture of the biopsied tissue may be done if there are no intact blisters to culture. Also, viral DNA (deoxyribonucleic acid) may be detected using PCR (polymerase chain reaction) on the tissue taken from the biopsy. This test is expensive and not routinely used.

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