What to Know About Telehealth for Shingles

Even though prompt diagnosis and management of shingles are key to shortening its course and reducing the risk of postherpetic neuralgia (a chronic, painful complication), the COVID-19 pandemic made this challenging. Patients were understandably hesitant to see their healthcare providers in person due to concerns of COVID-19 exposure and spread.

While healthcare providers are now taking excellent precautions to still see patients in their office or clinic, the vast expansion of telehealth services during the pandemic has allowed those with ailments like shingles to effectively access care from the comfort and safety of their own homes (if they desire).

When to Use Telehealth for Shingles

Most cases of shingles can be addressed through a telehealth visit. Specifically, you may consider scheduling a telehealth visit with your dermatologist, primary care physician, healthcare provider, or advanced practice nurse for the following reasons:

• To be evaluated for shingles if you develop a rash (usually small, red bumps that turn into blisters) around one to five days after pain/tingling/itching in that same skin area develops
• To review pain or sensory disturbances that persist even after the skin lesions have healed (two to four weeks, usually)
• To review the side effects or dosing of drugs given to treat your shingles, such as an antiviral medication and a nonsteroidal anti-inflammatory drug (NSAID)
• To troubleshoot a possible shingles-related complication (e.g., if you think the rash may be getting infected)

Benefits and Challenges

Research suggests that when it comes to skin disorders, telehealth services reduce cost and offer similar care as in-person visits. Moreover, telehealth for skin conditions (teledermatology) is particularly useful in settings where dermatologists are unavailable, inaccessible, or both.

As a shingles rash can transmit the chickenpox virus to susceptible people, a telehealth visit prevents exposing other people at the clinic.

Additional benefits of teledermatology include:

• Fostering early diagnosis and prompt management (waiting to see a dermatologist in-person may delay treatment, allowing for the condition to worsen)
• Allowing for close follow-up and monitoring of complications such as a bacterial skin infection or eye inflammation (called herpes zoster ophthalmicus)
• Improving the diagnosis and treatment of skin disorders (a dermatologist may change the diagnosis initially provided by a patient's primary care healthcare provider)

With the current COVID-19 pandemic, telehealth also allows individuals to receive health care while minimizing the risk of contracting or transmitting the COVID-19 virus.

Avoiding possible COVID-19 exposure in a healthcare provider's waiting room or through public transit is especially important for older adults and those with a weakened immune system, as they are at a higher risk for developing a severe COVID-19 case.

Using telehealth services for shingles poses a few challenges. For one, a healthcare provider cannot perform a comprehensive skin exam through a virtual visit. In addition, a patient may find a virtual visit too impersonal or experience difficulties displaying their "rash."

Health-related privacy is a general concern. As telehealth services continue to evolve and become more standardized, concerns about patient confidentiality will hopefully become less of an issue.

Technology-related issues are also something to consider, especially considering shingles are more common in older adults (although it can occur in patients of any age).

Older adults may have limited access to a computer or smartphone or have difficulty operating the telehealth platform. Likewise, access to a high-speed Internet connection or camera-related issues may cause disruptions to the virtual visit that affects its quality and outcome.

How to Prepare for a Telehealth Visit for Shingles

If you think you may have shingles or you have already been diagnosed with shingles but have a question regarding its course or treatment, it's a reasonable step to promptly schedule a telehealth visit with a board-certified dermatologist.

If you do not have a dermatologist or your dermatologist does not provide telehealth services, you can search online for one through the American Academy of Dermatology. You may also consider using an online telehealth company, such as TeleDoc or Doctors on Demand, to find a dermatologist.

If a teledermatology visit is not possible, seeing your primary care healthcare provider or an advanced nurse practitioner will also generally suffice. Shingles is a common skin ailment, so most primary healthcare professionals are very comfortable diagnosing and treating it.

After scheduling your appointment, you will want to be as prepared as possible. Your first step will be to clarify the telehealth service you are using and the logistics behind it.

For example, if you are undergoing a video visit, be sure you have the website link or app available that you need to connect to your provider. In some instances, you may need to set up a specific telehealth platform on your laptop, tablet, or smartphone prior to your appointment.

If you are expecting a phone call from your provider, be sure you write down the time you can expect the call to occur.

To get the most out of your appointment, you will also want to perform these preparatory steps:

• Designate a quiet, well-lit room to have your telehealth visit in.
• Consider purchasing or borrowing headphones to help block out noise or give you extra privacy.
• If having a video visit, make sure you have access to a strong and stable Internet connection.
• Test your device's microphone and camera.
• Ask a friend or arrange for a sitter to provide child or pet care during the time of your visit, if applicable.
• Write down any and all questions and concerns you would like to ask your provider.

Prior to your appointment, the American Academy of Dermatology also recommends avoiding irritating your skin or altering the appearance of your skin (e.g., avoiding hot showers, picking at your skin, or applying skin products).

Taking pictures of your affected skin is also a sensible preparatory step. Your dermatologist may ask that you send the pictures through email, text, or your patient portal.

When taking pictures, be sure to take them in a room with bright, natural lighting. Don't hesitate either to ask a partner, friend, or other loved one to take the pictures for you, especially if the problem areas are in a challenging location, like on your back.

Finally, if the affected area is small or the rash is hard to see, you may try circling it with a marker or taking multiple pictures from different angles.

On the day of your appointment, you will also want to:

• Double-check that your phone or computer is fully charged.
• Wear loose-fitted, comfortable clothes, especially pertaining to the skin area of concern. If the rash is on your face, do not wear any makeup.
• Log on to the program/app/website (if a video visit) 15 minutes prior to your appointment.
• Have a backup plan if you get disconnected from your provider. For example, make sure your provider has your correct contact number so they can call you if a technical glitch occurs—like your Internet going out or the camera stops working.

What Happens During the Visit

Your telehealth visit will proceed in a very similar manner as an in-person visit.

Your provider will greet you and then briefly review your medical history and medication list. Since you are calling about a specific concern (shingles), your provider will likely jump right into asking you questions about your skin and symptoms.

Example questions may include:

• Do you have pain, and if so, is it limited to the area of the skin affected by the rash?
• Are you experiencing any unusual skin sensations (e.g., itching, throbbing, burning, stabbing, or tingling)? Did these sensations precede the development of the rash?
• Have you had a fever or headache?
• How long has your rash been present? What did it look like when it first started?

Next, your provider will ask to see the rash on your skin, either through video or a picture. Since a shingles rash always corresponds to a dermatome, the rash will "crop up" in one part of the skin on one side of the body.

As a result, you should not have to fully undress, but you may need to remove or lift up a single article of clothing during your visit (e.g., shirt or pants).

After the exam and assessment are over, your healthcare provider may confirm a diagnosis of shingles and rule out alternative diagnoses like herpes simplex virus (HSV), impetigo, contact dermatitis, an autoimmune process, or a drug reaction.

You may be prescribed a combination of antiviral and pain-relieving medications. These medications can be prescribed electronically to a home delivery service or to your local pharmacy, based on your preference.

In some cases, you may also be asked to come in for an HIV blood test, mostly only if you have risk factors for HIV. Even though shingles is seen in healthy individuals, it's more common in individuals with a weakened immune system.

Lastly, if you are experiencing a more severe or complicated case of shingles, your provider may still ask you to come in for an in-person visit. This is done to ensure optimal care of your condition.

A Word From Verywell

If you or a loved one is diagnosed with shingles, try to remain patient and proactive in optimally caring for yourself as the rash heals. This means following up with your healthcare provider as advised, dutifully taking your medication, resting, and drinking fluids.

Also, consider engaging in soothing activities like listening to music, watching a movie, or snuggling with your pet to help distract you from the discomfort and perhaps psychological effects (e.g., social isolation) of this viral infection. Don't suffer in silence either—reach out to a friend, family member, or neighbor to talk about how you are feeling.

On a final note, keep in mind that regardless of whether you have had shingles or not, it's a good idea to talk to your healthcare provider about getting the shingles vaccine (if you are age 50 or over). With the vaccine, even if you do develop shingles, your infection may be less severe and you have a smaller chance of developing postherpetic neuralgia.