Shingles / impetigo / folliculitis / deep skin tissue complaint

[HowNowWhatNow]

I have Hashi’s and have this week had a new skin issue arise, on my neck.

It’s being treated as shingles, with anti virals, but could really be 101 other things (impetigo/ folliculitis / abscess / cutaneous lupus / you name it) and I don’t have confidence in the diagnosis because the symptoms don’t look all that shingles-y, being as it’s just a small place and not across a wide band, as it typically is. And I don’t have any of the systemic shingles symptoms.

It started as a deep and painful lump under the skin on Monday, with nothing visible on the surface, before exploding into a red raw skin / oozing lesion type of thing by Tuesday. It hasn’t spread since.

My GP prescribed me anti-virals, which had been suggested for me in Urgent Care the day before. But neither GP not Urgent Care were very convinced it was shingles - they just wanted to make sure I had the medication within the 72 hours, in case it was shingles.

What do you do in these circumstances, when medication is prescribed just on the off chance and things are then left up to see how it goes?

Wait and go back in a week if it’s still there? Push for better diagnostics so that doctors don’t just carry on in the same “more likely to be a horse than a zebra” vein? And if so, what would they be?

Sorry for the extremely vague set of facts. I can describe the situation better, if helpful.

I am having bloods drawn next week. Are there any bloods that might be helpful in resolving this type of issue?

Thanks.

[SimonWaters]

Did they try and culture anything from it in case it is bacterial? Doesn't sound thyroidy, closest that is thyroid specific would be hives which crops up a lot, but wouldn't be surprised if its related in some way.

[HowNowWhatNow in reply to SimonWaters]

Thanks.

No cultures, no temperature / B pressure , no swabs, no urine samples or other diagnostics.

Is dermatitis a thyroid-y thing to get?

[anniec11 in reply to HowNowWhatNow]

Just wondering, have any of you had the Shingles vaccine?I assume it isn't connected to one of the two shingle vaccines?

[HowNowWhatNow in reply to anniec11]

i haven’t, no

Thanks for asking

[HowNowWhatNow]

And a related question for coeliacs / wheat intolerance sufferers.

What skin symptoms do you get, if you start eating wheat by accident or on purpose?

I had errred and strayed from my GF path a few times this week and suddenly wonder whether I should put the 2 and 2 together to make ..

[helvella in reply to HowNowWhatNow]

Have you looked up Dermatitis herpetiformis?

Dermatitis herpetiformis

What is dermatitis herpetiformis?

Dermatitis herpetiformis is a rare but persistent immunobullous disease that has been linked to coeliac disease (U.S English: celiac), a gluten-sensitive enteropathy.

The name herpetiformis is derived from the tendency for blisters to appear in clusters, resembling herpes simplex. However, dermatitis herpetiformis is not due to viral infection.

Dermatitis herpetiformis is also known as Duhring-Brocq disease.

dermnetnz.org/topics/dermat...

[HowNowWhatNow in reply to helvella]

I have looked it up this morning. What I have doesn’t look “bullous” in the herpetic way that shingles or this kind of dermatitis has. It looks more herpetic in the way that impetigo has. I am going to go cold turkey off gluten again and see if this helps.

Thank you.

[PurpleNails Administrator]

You are the 2nd shingles post this week & I posted a few months ago.

I read there is theory of a link with vaccine & shingles - which makes sense as shingles often occurs when immune system “run down”. 

I made error of arranging 2 separate vaccine with 2 weeks - I was assured it was ok to do but I developed shingles later that month.

NHS website says - When people get chickenpox, (usually as children) the virus remains in the body. It can be reactivated later and cause shingles if someone's immune system is lowered.It’s not usual to test for either chicken pox or shingles - (varicella zoster.)   

Your dr could only test to see of you had chicken pox in past by blood sample to look for proteins which fight it (the antibody).  

It is also possible to take a sample from the blister scabs and look for presence of the virus.  - but this is rarely undertaken as it’s usually accurately diagnosed by appearance & treating potential cases safer than leaving or testing.  

The delay taken to complete test would likely  exceed the window to commence treatment (72 hours).

I would start the anti virals if you hadn’t.

If it is shingles you cannot spread shingles to others - But people who have not had chickenpox before could catch chickenpox from you.  

The rash does not always appear in a band, although it will be 1 side and roughly follow a nerve path (called dermatomes)  it can appear in small clusters.  I had a certain patch which was particularly troublesome & almost rectangular.

 I agree the description you give on an initial lump sound different.  Symptoms such as headache often start before hand. 

The rash is deeply itchy on surface & painful underneath.  I was recommended soothing calamine cream at chemist. I believe some anaesthetic creams can be tried & I did consider buying a capsicum creme.  

I was offered Amitriptyline for nerve pain & said I would consider if pain persisted but it did settled so didn’t opt for it.

Other forms of antidepressants/ anticonvulsant are also sometimes recommended for treatment.  1 in 5 find the deep pain lingers. (Post herpetic neuralgia).  

[HowNowWhatNow in reply to PurpleNails]

Purple Nails thank you and yes I read that post and quite a few more. I also read a few accounts from people who have shingles on a U.S. forum. Their general practitioners seem to be a lot more proactive in testing than ours.

Skin conditions are so hard to narrow down!

Yes I am taking the anti virals. Started taking them less than 48 hours from getting the visible rash / lesion.

I say “lump” but it didn’t stick above the rest of the skin. There was a very tender area of the skin, which felt harder / denser than the rest to touch. Running along the nerve / bone / whatever firm structure in the neck it sits on.

How long did yours last for? And did it come back again?

[PurpleNails Administrator in reply to HowNowWhatNow]

The rash was in a difficult place to view.  (Top of thigh) - I was told it looked better by 2 weeks - stopped need to applying cream within a month.  

Although even now I have to switch off my heated car seat, as the warmth sets off the area tingling.    

[HowNowWhatNow in reply to PurpleNails]

What kind of cream was this - Zovirax?

I now completely see why at least two of my female medic friends made sure their children were vaccinated against chickenpox as babies.

[PurpleNails Administrator in reply to HowNowWhatNow]

no a chamomile cream. A solution used to be recommended & what I had when had chicken pox, but apparently the lotion dries quickly & stops helping. A cream last longer. The chemist looked it up when I asked for a cream to help shingles.

Some have been prescribed a lidocaine cream & the other option Is capsicum warming creme.

I don’t know of Zovirax cream can be used for shingles, it’s specifically for cold sores. Your chemist would likely be able to answer.

[helvella in reply to HowNowWhatNow]

My shingles took 17 days from first appearing to having flat reddish skin patches where the papules had been. Still painful and using lidocaine.

Now a year and 11 days (I'm counting! ) after papules started, still pain in shoulder and neck and arm. But as a postherpetic neuralgia type now. Capsicum cream keeps me going!

[HowNowWhatNow in reply to helvella]

Sounds horrible

[HowNowWhatNow]

Zovirax is topical acyclovir cream, so yes is recommended. Was recommended to me by a doctor, too.

Thanks for all your advice.

[helvella in reply to HowNowWhatNow]

The Patient Information Leaflet doesn't mention Herpes zoster - just simplex. Which suggests it might not be very (or at all) effective.

1 What Zovirax is and what it is used for

Zovirax Cream (called ‘Zovirax’ in this leaflet) contains a medicine called aciclovir. This belongs to a group of medicines called antivirals. It is used to treat cold sores and genital infections caused by the Herpes simplex virus. It works by killing or stopping the growth of viruses that cause cold sores or genital herpes.

medicines.org.uk/emc/files/...

[AbiKat1]

Sorry to hear this, I wonder if you are having any pain in your body on the same side. This can sometimes be a symptom with it as well.

I have had shingles and mine started very much the same on my face, the anti virals are definitely worth taking as soon as possible to prevent escalation of it, if it is that.

Did you know a lot of shingles are internal as well and do not always reach the skin surface. I had tremendous nerve pain with mine as a lot were internal on a nerve.

They can do antibody tests before and after to confirm if it is - varicella zoster or herpes zoster.

You can also have swabs done for viral or bacterial. After shingles I had Ramsey hunt a year later - part of the same zoster group. This was confirmed with a swab, I had one spot in my ear. Iv found before shingles and Ramsey hunt my skin tingled and my head ached and pain one side. They were my symptoms.

Kings college hospital London gave my diagnosis.

I hope you can get to the bottom of what it is. I would personally take the anti virals to cover all bases if that’s what the doc recommends.

All the best with it!

[HowNowWhatNow in reply to AbiKat1]

Thank you Abi Kat, this is so helpful. I wish my GP had told me 1/20th of this, but at least now I know.

[ICE187]

A dermatologist would be best. Do you have bruising around your eyes or tongue enlargement? Kidney, heart or liver issues that go along with your thyroid issue?

[HowNowWhatNow in reply to ICE187]

I have globus in my throat and iron deficiency. Reasonably frequent UTIs so poss kidney issues but nothing on scan or in blood tests.

[HowNowWhatNow in reply to ICE187]

thanks

[HowNowWhatNow in reply to ICE187]

Also rosacea which could be lupus - said dermatologist last time I saw one

Also very new red bumps on left hand which going by the internet cd be a new Raynaud’s symptom - which I also have

[ICE187 in reply to HowNowWhatNow]

Have a look online for images of Primary localized cutaneous Amyloidosis, Primary localized cutaneous nodular Amyloidosis. Your GP should be able to check your blood for Amyloid proteins if this is suspected. Just before my diagnosis of hypothyroidism, my face would develop a rash as well as my lower legs. A doctor mentioned Amyloidosis, but that was mainly due to liver and kidney issues with the rash. It can cause hypothyroidism. My rashes, liver and kidney issues got much better once I got on the correct dose of levothyroxine. I never did test for Amyloid proteins.

[HowNowWhatNow in reply to ICE187]

Thank you ICE187.

I don’t have the eye bruising the pictures show but do have some of the other symptoms.

What was it about my symptoms that particularly suggested this condition to you?

I am due to see a rheumatologist this week and to have GP- led blood tests so will ask the rheum about the condition and the GP if they might also test for amyloid protein.

[ICE187 in reply to HowNowWhatNow]

The eye bruising and tongue swelling don't always occur. Seeing that you have thyroid issues and skin issues, it hit me when my doctor made the suggestion. After researching the causes of hypothyroidism, Amyloidosis was one of the causes. It can mimic lupus as well. onlinelibrary.wiley.com/doi....

dermnetnz.org/topics/cutane...

pubmed.ncbi.nlm.nih.gov/746...

[HowNowWhatNow in reply to ICE187]

Thanks again.

Looking more closely at the photos, the amyloid type of condition doesn’t look like an obvious match with what I have - which is a recent raw and oozing patch of skin, which hurts and red itching and painful raised spots on the scalp, for over 6 months.

But you never know!

[ICE187 in reply to HowNowWhatNow]

Hopefully amyloid isn't the case. With thyroid issues, it creates so many other issues that look like other issues.

[Highwaytoheaven]

Also have Hashi's and had a weird rash on my the back of my neck. Then got rashes on my leg and arm. Just been to the dentist and had an infected root canal tooth pulled. The rashes are subsiding, I'm on antibiotics and an immune booster.

[HowNowWhatNow in reply to Highwaytoheaven]

Interesting. Glad your tooth is out and your symptoms subsiding.

Did the skin symptoms compel you to have the tooth out or to look into the teeth, or did you also have tooth pain?

[Highwaytoheaven in reply to HowNowWhatNow]

No been having skin issues for years. The tooth got loose and painful. The dentist said the infection had been there for a while, there were abcesses on the surrounding tissue. I really don't know if this was the cause of the rashes, but they started to subside a day after the tooth was pulled.

The dentist also said with root canals your body can deal with the infection most times. Difficult to know when to investigate your teeth as a possible cause of other ailments

[HowNowWhatNow in reply to Highwaytoheaven]

The cross-over / not between head, neck & ENT issues with dental has made all my neck and above symptoms of the last year so much harder to deal with than they should be for the patient.

I’ve seen

Maxillofacial surgeon & X Ray and ultrasound ordered by them

ENT & ENT surgeon & lip biopsy & ultrasound ordered by them

Dermatologist for scalp and face & blood tests / swab by then

Hospital dentists for mouth & salivary glands & ultrasound by them

None of them has looked more closely at the structures of the ear, I now realise. All have declared ignorance about thyroid nodules (once detected). None has spoken to any of the doctors I’ve seen from the other disciplines to theirs.

Impossible to understand why they don’t run multidisciplinary one stop shops for head and neck patients until the locus of the problem is found.

[HowNowWhatNow in reply to Highwaytoheaven]

And I forgot to mention dentist.

I hope you continue to feel ever better.

[Highwaytoheaven in reply to HowNowWhatNow]

Oh my goodness you have been through so much looking for answers. I do hope you find some soon. Its a constant battle. I have tried so many things to feel well. It's very frustrating. I do hope you get relief. The rash can be worse than the other pains

[Roulette26]

I’m also suffering from a weird rash at the moment. Fortunately I am seeing a dermatologist, privately I might add because after discovering that the community dermatologist was seriously ill with no indication of when he was returning I paid to see one. The rash was not an issue at that time, it’s something very recent. She prescribed various lotions and potions and took skin scrapings. Then offered a biopsy, because she was completely at a loss for a diagnosis. Which means instead of messing around for potentially months i will know within the next few days what’s going on.

Good luck

[HowNowWhatNow in reply to Roulette26]

thanks!

[Merrilymerrily]

Hi. Look into Bht...sold on amazon as a food preservative. Read all the comments there. Bht destroys the lipid envelope of viruses. Take it with a fat or oil. Take it in capsules!!!!!The taste and feel in the mouth is disgusting. Take a swig of olive oil afterwards. Seems like it is curing shingles and who knows what else...HIV, hepatitis, etc...

God bless and good health to you.

[HowNowWhatNow in reply to Merrilymerrily]

thanks!

What does BHT stand for?