Take the Shingles Quiz Shingles Slideshow Pictures Gallery of Skin Problems and Image Collection

Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Shingles Diagnosis

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 infection (shingles). This is the most frequent way shingles is presumptively diagnosed. The rash may occasionally extend outside of this band or, infrequently, to the other side of the body. Rarely, there may be only pain in a dermatome band without a rash.

• The doctor may decide to do tests to confirm that a patient has shingles. However, these tests listed below are not always necessary, as a presumptive diagnosis based on clinical findings is often definitive enough for diagnosing shingles.



• A Tzanck smear, which is less commonly performed now since newer techniques are available (see below), involves opening a blister and putting fluid and skin cells from it on a glass 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 types may cause 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 types. 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.