Is It Shingles or Psoriasis? Learn the Signs

Medically reviewed by Debra Sullivan, PhD, MSN, RN, CNE, COI on May 24, 2016Written by James Roland on November 6, 2015

Intro

Two of the more serious skin conditions you can have are shingles and psoriasis. They can both affect large areas of the skin with itchy, painful rashes. These rashes are both challenging to treat.

Shingles and psoriasis

Shingles

Shingles itself cannot be passed from person to person. You can, however, catch the virus that causes shingles from a person who has shingles. The virus that causes shingles is called “varicella-zoster virus.” The varicella-zoster virus, which can be in your body in an inactive form for years, is the same one that causes chickenpox. It can become active again at any time, and it can cause a rash and blisters. If you previously had chickenpox, you could develop shingles from the reactivated virus. You can pass the virus to someone who isn’t immune to chickenpox if you have shingles, even if it’s inactive. If you pass the virus to someone who hasn’t had chickenpox, that person could develop chickenpox but not shingles.

The virus is spread by contact from fluid of the rash blisters.

The virus lives in the nervous system. When it’s activated, it moves up the nerves to the outer surface of the skin. Once the rash from shingles crusts over, the person is no longer contagious.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 3 people will develop shingles at some point in their lives, with an estimated 1 million cases of shingles each year in the United States. The risk of developing shingles increases with age, with approximately half of all cases appearing in those who are 60 and older.

Psoriasis

Psoriasis is a chronic autoimmune disorder. Unlike shingles, it’s not contagious. People with psoriasis will experience periods of remission followed by flare-ups. It’s associated with rapid skin cell turnover.

There are multiple types of psoriasis, which are:

  • plaque
  • guttate
  • pustular
  • inverse
  • erythrodermic

Patients can get more than one type of psoriasis, and it can appear on different places on their body at different times throughout their lives.

According to the American Academy of Dermatology, 7.5 million people in the United States have psoriasis. Many begin to see symptoms between 15 and 30 years old. Another peak time for psoriasis symptoms is between the ages of 50 and 60. People who get psoriasis usually have at least one other family member who also has it.

There’s no cure for psoriasis. Steroids and drugs that suppress the immune system can help treat flare-ups as well as light treatments.

Symptoms

Shingles

A shingles rash can appear anywhere on your body. Often, though, it’s found on the right or left side of your torso. It may also spread to your back, chest, or abdomen.

The rash is usually quite painful, itchy, and sensitive to the touch. Often you’ll feel pain at the surface of the skin a few days before the noticeable rash develops. If treatment is given promptly, the rash can develop into blisters that open and form scabs.

Other shingles symptoms may include fever, fatigue, and headache.

Psoriasis

Psoriasis may also appear on your torso, but the patches of dead, scaly skin typically form on the scalp, knees, and elbows. Psoriasis may also affect your fingernails and toenails. The red rash of psoriasis may be covered with silvery scales or dry, cracked skin. The affected areas may itch or burn.

Psoriasis can also affect the joints, making them feel stiff and sore. This condition is known as psoriatic arthritis.

Diagnosis

In order to treat you, your doctor will need to diagnose the condition first.

Shingles

Early symptoms of shingles may be confused with hives, scabies, or other skin conditions. Sometimes, diagnosis is as simple as viewing the rash itself and the associated symptoms. Further testing typically is not necessary.

However, further testing is available. If you’re at risk for other complications because of shingles, doctors can order the following tests to diagnose the virus:

  • viral cultures or antibody tests of samples taken from the blister
  • skin biopsies, where a piece of the rash is removed and evaluated under a microscope

Psoriasis

Diagnosing psoriasis is similar to diagnosing shingles. Doctors can typically diagnose psoriasis just with an examination of your scalp, nails, and/or skin, along with a medical history. On occasion, your doctor may order a skin biopsy of the rash to diagnose psoriasis and rule out other conditions. This can also help to diagnose the exact type of psoriasis.

If you’re experiencing a persistent rash that doesn’t go away, along with other symptoms of pain or fever, consult your doctor. Treatment is available for both shingles and psoriasis, and can help you feel better.

Treatment

Whether you have psoriasis or shingles, there are treatment options available for both. Treatment will obviously depend on which affliction you have.

Shingles

While there is no cure for shingles, treatment is still available to make patients more comfortable and decrease the duration of the disease, which generally lasts between two and six weeks. Treatment for shingles includes:

  • antiviral medications to speed up healing and reduce the chance of complications
  • nerve pain medications, or numbing agents, like lidocaine, to help with the pain

Shingles start with pain, with blisters following soon after. At the end of the virus’s course, these blisters will crust over. You are most contagious when your blisters appear and have not yet crusted over. Before and after this stage, you aren’t contagious at all. If these blisters aren’t properly treated, it could lead to bacterial skin infections. Scarring will depend on the severity of the rash and how well it was treated.

Psoriasis

Treatment for psoriasis can be slightly more complicated. While there is no cure for either shingles or psoriasis, shingles is caused by a virus that will affect you once, while psoriasis is a permanent, chronic condition. Managing psoriasis revolves around treating the symptoms and keeping flare-ups at bay.

Treatment options include:

  • Topical medications, like cortisteroids, to reduce inflammation and redness, or tar shampoo, to treat scalp psoriasis and flaking.
  • Oral medications, like Acitretin or Otezela, require frequent blood work to monitor the effects on the patient.
  • Biologic medications, which target specific parts of the immune system instead of the entire system, can target specific proteins that are associated with psoriatic flare-ups.
  • Phototherapy, where UVB light is applied to the skin to help treat flare-ups and symptoms. Phototherapy can be done in a medical facility or at home with a specialized lamp.

Flare-ups from psoriasis are typically caused by some sort of trigger, and can last anywhere from a few days with medication to a few weeks.

Scarring is common among those with psoriasis, particularly in patients with plaque psoriasis. By keeping skin moisturized, applying ice packs to the skin, and keeping your medications handy, you can reduce the likelihood or severity of scarring.

Preventing shingles and psoriasis

Shingles

The risk of getting shingles increases as you age. Fortunately, there is a shingles vaccine. The CDC recommends that everyone ages 60 and older be vaccinated against shingles, even if you had the chickenpox when you were younger. It cuts your risk of developing shingles by 50 percent.

The vaccine is good for about five years. It’s important to keep up your protection. The complications from shingles can be more serious the older you get. If you’ve already had shingles, you can and should get the vaccine to avoid getting shingles again.

Psoriasis

There’s no psoriasis vaccine. While you cannot prevent psoriasis, there are steps you can take to try to reduce your symptoms. One thing you can do is to try to eliminate or reduce your exposure to psoriasis triggers, such as stress and irritation or injury to your skin, including sunburn.

If you smoke, you should quit. If you do drink alcohol, drink in moderation. Avoid infections as much as possible to help you avoid flare-ups or make it easier for you to deal with them if you do have them.

Risk factors

Shingles

The risk factors for shingles include advancing age and having a disease that weakens your immune system. This includes cancer, HIV, and AIDS. Cancer treatments can also lower your resistance, making it more likely that an inactive shingles virus could become active.

Psoriasis

Psoriasis risk factors tend to be more related to family history. If you have a close relative with psoriasis, your odds of also having the condition go up. Like shingles, psoriasis is more likely to appear in individuals with HIV and other serious infections. Smoking, stress, and obesity are also risk factors.

When to see your doctor

See your dermatologist at the first sign of a rash, blisters, or a patch of dead skin. You can also see your primary care physician who may refer you to a dermatologist if the condition is serious. If it appears that you have psoriasis, you may need to see a rheumatologist who treats autoimmune conditions such as psoriatic or rheumatoid arthritis.

Early diagnosis and treatment can often control symptoms. You shouldn’t ignore the signs of either shingles or psoriasis.

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