283: Is Your Rash Actually Shingles? w/ Dr. Mamina Turegano

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If you've ever joined a Facebook group and uploaded a picture of a crazy, bumpy rash and someone told you to just put a cream on it, there's no shame here. However, some people may actually have shingles, and you can't just “put a cream on it”! In honor of National Shingles Awareness Month and Week, I wanted to bring in an amazing expert on the topic to dish out the facts and what to watch out for.

My guest today is Mamina Turegano, MD,. She's a triple board-certified dermatologist, internist, and dermatopathologist practicing at Sanova Dermatology in the greater New Orleans area specializing in medical and cosmetic dermatology. Dr. Turegano has a special interest in evaluating how nutrition, lifestyle, sleep, and other environmental factors can play a significant role in inflammation, aging, and cancer. She is a recent graduate of the Integrative Dermatology Certificate Program. In addition to providing skincare tips and knowledge on dermatological conditions through her social media platforms, she shares her Japanese mom’s anti-aging tips, which incorporate holistic and traditional Japanese beauty practices.

Have you ever had shingles? How did you find out, and what did you do for it? Share with the community in the comments below!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

• What are shingles + how is it different from chickenpox?
• Is shingles just an “old person's” health issue?
• Signs + symptoms of a shingles outbreak
• Possible triggers for shingles
• Treatment options for shingles
• Are shingles contagious + who should be cautious around someone with shingles?
• Can you get shingles multiple times?

Quotes

“Stress… I would say that's probably the number one trigger is stress.” [6:35]

“Eczema herpeticum is actually related to herpes simplex. So different variant, but it can look similar if eczema herpeticum is localized to one area.” [21:52]

Links

Follow Dr. Mamina on Instagram | Twitter | Facebook | TikTok

Check out Dr. Mamina on her website

Healthy Skin Show ep. 106: What The Heck Is Eczema Herpeticum? w/ Abby Lai

 

283: Is Your Rash Actually Shingles? w/ Dr. Mamina Turegano FULL TRANSCRIPT

Jennifer Fugo: Dr. Turegano, it's so nice to have you here. I know we've been working on having you on the show for a long time, and I'm excited for this conversation today.

Dr. Turegano: Thank you so much for having me. I've been really looking forward to this.

Jennifer: So, um, I will say that it's, I'm not having a little bit of a fan girl moment because you have such a big following on like TikTok and Instagram and you have such a trust factor that you've built up with your audience, which is why I was so excited to have you come on the show. Um, and, and, uh, one of the reasons why is that, so we're talking about shingles today and I feel like most people feel like or think that shingles is an old person problem, right? It only happens in old people except for the fact that I ended up with shingles when I was 27 years old. And I knew what shingles was because I worked for my dad who was an ophthalmologist and we used to see shingles in his practice quite a, a quite frequently. And so I thought let's have this conversation because I'm oftentimes seeing, um, conversations in like Facebook groups where people have eczema and whatnot. And unfortunately what really sounds and looks like shingles to me there's people like, oh, just try this cream or that cream. And I'm thinking in my head, this person should really go see a doctor. So I think that having a conversation about shingles is important. So let's start off with what exactly shingles, what is shingles?

Dr. Turegano: Yes. So shingles, the other name for shingles is herpes zoster and it's caused by the varicella zoster virus. It's actually in the family of herpes viruses. There's like, you know, eight or nine actually there's d multiple different types of herpes viruses. I think most people are familiar with herpes simplex, which causes like fever blisters and genital herpes. But this is another variant of a herpes virus and it is what causes chickenpox when you are younger. We're not seeing chickenpox as much these days cuz everyone's getting vaccinated. Um, but, but basically, so we may not see shingles, you know, in the future because a lot of people aren't getting chickenpox now. But if you had chickenpox in your younger years, that virus lives dormant in a nerve root. So in a nerve root, somewhere down your spinal cord and it just lives there forever. Herpes viruses are forever.

And um, that replies to other herpes viruses too. It's just forever. And you know, normally it's just kind of like chilling, laying low. But as your immune system changes, if there, or if there's a trigger over time that, um, does something with your immune system, then that virus can awaken and wherever it lives. So it lives, like I said, it picks, it picks one part on your spinal cord where it likes to live and wherever it's living, it's gonna affect the nerves that come out of that section of the spinal cord. So, um, yeah, if it's like somewhere in the thoracic, like, so there's like the cervical cord, the cervical part of the spinal cervical spine, thoracic spine and lumbar spine, and then sacral, um, spine. And, um, so if it's, you know, somewhere in the thoracic spine, it's usually just you'll, you'll see it on the back and it, that nerve wraps around to like your ribcage.

Um, and there's different levels and we call that section of skin a dermatome. So that nerve, like whether it's like, so there's, you know, C1 through C7, then like, you know, then there's thoraic region, I'm not gonna all of them mention all of them. Like L1 through L5. Yeah. And depending on which nerve it is, it'll affect the dermatome. So the section of skin that nerve innervates. And um, that's why when you see shingles, it's unilateral, meaning it's only one-sided. It, its only it lives in that one nerve root that wraps around or, um, deals with that part of the skin.

Jennifer: And is this something where when you get it, like what does it actually look like?

Dr. Turegano: Yeah, so classically shingles presents as a collection of little blisters. That's just when it's at its full ripe form, you'll see a patch or collection of tiny little blisters, we call them vesicles. That's the medical term for it, just which are just filled with like watery, serious fluid. Um, but it can present in a variety of different ways. And I've personally been stumped by, by shingles, um, because sometimes it can, it can look like a red rash, like an eczematous rash. It can sometimes look like bug bites, just like red bumps. Um, sometimes it'll just initially show up as pain. I've had actually, one of my, my office manager <laugh>, she was dealing with the most severe back pain, no skin manifestations at all. And it was so bad she had to go to the er. And then a few days later, I mean these blisters just exploded. So sometimes the initial sign could be just itching, burning or just painful sensation on that part of your skin.

Jennifer: Yeah, I'll share that. Um, initially I kept feeling like something was scraping my lower left back area and I kept pulling up my shirt and asking my husband, I'm like, is there something on my shirt? Is there something on my back? Like, are there scratches? And he's like, no, I don't see anything at all. <laugh>. Yeah. And it felt so irritated I couldn't have anything touch that area and it was mm-hmm. <affirmative> like two to three days of that before all of a sudden I started having red dots pop up mm-hmm. <affirmative> mm-hmm. <affirmative>. And that's when I was like, I think I have shingles and my mom's like, you don't have shingles. There's no way you're only 27 and you have shingles.

Dr. Turegano: Mm-hmm. <affirmative>. Yeah. Yeah. Yeah. That's a, that's a pretty good presentation.

Jennifer: Yeah. So how, how do you think you end up with shingles? Like what, are there any triggers that people should be aware of?

Dr. Turegano: Yeah, so, you know, um, you know, classically we do think of it as a quote like older person disease because our immune system does, I guess shift, I don't wanna say it weakens. I mean it, it does as we get like really, really old, but it sort of shifts and, um, you know, whether it's like hormonal changes too can play a role, but really it's anything that can affect your immune system. So we do see it in people in their younger years. So really if you think about what, what affects your immune system, stress, I would say that's probably like the number one trigger is stress. There could also be if, if I've seen it where people were dealing with another, you know, uh, infection or another illness and they were just completely wiped out from that and that kind of lent themselves to develop shingles.

I've seen it also of just occur out of the blue. Like people are like, I'm totally fine, nothing new or different in my life. Um, so I'm sure there's some other like unable unidentifiable factors, something, I don't think this is established in the literature, but this is something I've learned from my partner. She was practicing for over 35 years. She just retired. But she has a theory that she thinks that if, in this, we may get into this when we talk about like if it's contagious, but she thinks that if people are around somebody with shingles, it can potentially trigger their own immune system to wanna break out in shingles too, which she's like, I don't know how that works, but like, I feel like I've seen that. Um, but uh, I would say probably the main two issues that I've seen are age and stress. Like, you know, trauma, like if, if people undergo something stressful

Jennifer: Mm-hmm. <affirmative>. Yeah. And if you are really sick, like say, you know, what if you ended up with like covid or a really severe infection of some sort, could that also be enough to allow for the, so the virus sort of reemerges? Is that a good way to describe it?

Dr. Turegano: Yes, it reemerges as shingles. Yeah. The chickenpox virus reemerges as shingles rash.

Jennifer: Mm-hmm. <affirmative> and, and something like getting sick could also possibly be a tri like would Epstein bar or something like that pretty serious or Lyme disease. Could that possibly trigger it? Maybe,

Dr. Turegano: Yes. I, I do think that that other viral infections could potentially trigger it because there are, there are certain viral infections and there are some that we haven't identified. I mean I'm sure EBV does a lot of random things, but there are some viral infections that can also affect like your white blood cell count, um, like your lymphocyte count, which is part of your right blood cells and can affect the integrity of your immune system. So, um, yeah, people have like chronic viral infections that, that can certainly play a role.

Jennifer: So if you feel like, you know, you have this weird area one side of your body and, and mm-hmm. <affirmative>, by the way, everyone, I did say my dad was an ophthalmologist, so we were dealing with a face, so you can get this on your face and up into your scalp. Um, if you feel like you are developing some sort of one-sided rash that has maybe this like kind of nervy presentation to it, do you have to go to the doctor? What, like what do you recommend as a dermatologist? I'm sure you've seen shingles cases plenty over the years. What do you suggest?

Dr. Turegano: I do suggest that if you do have one-sided nerve pain with some type of rash or skin presentation, I do definitely do recommend. I mean, even if you just have nerve pain too, you might see your primary care doctor, but if you have any kind of skin symptom that's one-sided, painful or you not necessarily be painful, but I would seek a primary care doctor or dermatologist to get on treatment quickly. And the reason why I recommend that is that when it's sort of unpredictable who gets really bad cases of shingles, perfectly healthy people can have really explosive, terrible cases. And it's those cases, if you have a bad case of shingles that can lead to what's called post-herpetic neuralgia, where there's almost like damage that's done to the nerves that the shingles, the, you know, the shingles like irritates the nerve that it lives on. And if there's a lot of inflammation and irritation on that nerve, it can lead to long-term nerve irritation or I don't wanna say it's neuropathy, it's neuralgia. So, pain and it's definitely not fun to deal with. So the more robust the shingles flare is, the more there's a higher chance of you having this neuralgia. And so you wanna catch this early if you can and get on treatment immediately.

Jennifer: Hmm.

Dr. Turegano: Now, now there are cases of course, where people can just live with it without ever getting on medication. But I would say to be on the safe side mm-hmm.

Jennifer: <affirmative>, yeah. There was one woman I remember in my dad's practice, she did not go seek medical treatment and let it go for about a month. She was this, um, elderly woman, super sweet, but she ended up in so much debilitating pain as a result and I remember that, I think that went on for months and months on end and she very much regretted not having gone to the doctors. So I was in a different story. I caught it really early. My derm was like, I'm impressed that you thought that's what that was. And I like, well, we saw enough in my dad's office, I knew I should get to see someone, but this poor woman didn't realize that and she ended up in excruciating pain and it ended up, I think she ended up with shingles, like in a, like it spread quite extensively, unfortunately.

Dr. Turegano: If, yeah, I was gonna say the other thing that you would also wanna be really cautious about, um, and catch really early is if you do have shingles, like on your forehead or on the tip of your nose, because then you could also, as you probably have seen in your dad's office, um, eye involvement and that can have long-term consequences, scarring of the cornea. Um, so, so yeah. And, and it can affect your vision. And then same with like, um, your ear too. Um, and your facial nerve could have like facial nerve paralysis and hearing loss. So, um, that's, that's if herpes is more so on like the, like the your cheek area. Um, so yes. So if it's on your face, definitely seek treatment soon.

Jennifer: Yeah. It's important. So what does treatment generally look like?

Dr. Turegano: Generally I prescribe an antiviral medicine called valacyclovir. The brand name is Valtrex and it's a one week course, it's 1000 milligrams three times a day for seven days. And I just have people start it pretty immediately. And then depending on how robust the inflammation is, if they have like a ton of blisters or if they're in a ton of pain, I may also do something to soothe the inflammation like, steroid medicine and, or depending on the pain, I'll start them on um, just neuropathic pain medicine, um, specifically gabapentin to get that under control from the get-go. And that has been shown in studies to, minimize the development of postherpetic neuralgia.

Jennifer: Wow. And, and, and this is important cause I know that, um, like we hadn't talked off beforehand off the air about lysine, which is used sometimes to help folks who are struggling with like cold sore outbreaks and whatnot. But I've seen, you know, this is like where it's like Facebook medicine, everyone Um, and, and listen, I, I get it. I, I understand wanting to try to like get an answer quickly, but the people on Facebook and on the internet don't know you. And sometimes there can be serious consequences to not taking appropriate steps. And I feel like this is one instance where that would be the case. So could lysine be helpful? Like if you're going through an active flare up, do you, is there any research on that or any clinical experience you have to share about lysine?

Dr. Turegano: I think that most of the research is done with, um, the other herpes virus. Like you mentioned, like herpes simplex, the one that causes fever blisters. But, um, theoretically it could potentially help. I don't think that it would at all replace, um, the effects of valcyclovir if you wanted to use it. I would use it more as like supportive treatment. Mm. The setting where I would recommend it for people is for, for my patients is if they get recurrent herpes flares, like more recurrent than they would want, um, and to incorporate that into their supplement regimen, um, that's where I find it to be the most useful. But it, it, it does have antiviral effects. So, you know, I think in theory that it can be helpful.

Jennifer: Would it be necessary in the case of shingles though? Like can you actually, I mean this is kind of a thought and I've always wondered about, cause I got it so young. Can you get shingles more than once? Or is are you like one and done?

Dr. Turegano: Great question. So the classic scenario is that you just get shingles once and that is it. But, I definitely have seen shingles occur twice on people. I don't think I've ever seen it occur three times. Um, but I've definitely seen it occur twice. So there's also like the shingles vaccine and so if people still have it, I think it's still recommended that people still get the vaccine, just they don't get it a second time, but yeah.

Jennifer: But yeah, you can possibly maybe get it a second

Dr. Turegano: Time, possibly maybe. Yes. <laugh> I know not

Jennifer: Fun. I was so, I was so excited when you're like, no, but I was

Dr. Turegano: Like, ah, yes, yes.

Jennifer: Yeah. Um, because it's nice to think like, okay, I got it, I'm good. Like, like chicken pox, you get it the one time and you're good.

Dr. Turegano: Yes, you're good. Yeah. I mean if you want to yeah. You know, play odds, it's you, you know, most people don't get a second.

Jennifer: Um Okay. Course.

Dr. Turegano: Yeah.

Jennifer: Do you, so let me go back to, you had said earlier a lot of people may not get shingles because they're getting the chickenpox, um, vaccine now. So do they they don't see, I mean, I don't know. I don't remember because I'm 42, so we did not have that vaccine when I I was a

Dr. Turegano: Child with me. No.

Jennifer: So do they have any research to see with and I mean, I don't know how old these, these, these children would even be to know whether shingles would show up with, if you were vaccinated for chickenpox?

Dr. Turegano: I think because you're not inoculated with the virus that it's not living in you. Um, oh, so so you can't Yeah, because yeah, you have to have chickenpox for it to be like infected and live inside your nerve. Okay. Okay. Um, so yes, you should not have theoretically shouldn't have shingles. Now who knows if like maybe getting the vaccine people may have like maybe now, now I'm just postulating. People just can have more, you know, kind of subdued cases of chickenpox, like where they have like even zero symptoms and then the virus could just like be living in them and maybe do something later. I don't think, I don't know if anything's come out with that, but Mm. But we, you shouldn't be getting shingles if, if you don't get chickenpox.

Dr. Turegano: Yeah, probably your thoracic or lumbar Yeah. Area. Mm-hmm.

Jennifer: <affirmative>. Mm-hmm. <affirmative>. Yeah. Oh, that's so fascinating. I did not know that I, I learned much from these podcasts and getting to talk to experts like you. Um, so I'm so glad. I think this is an important question and this is something that I think, you know, could be helpful for people. So, and, and maybe this underscores why it's important to seek medical treatment and, and be careful with shingles, but is it contagious?

Dr. Turegano: That's a great question. It is, it is not contagious. So, okay, sorry, let me back up. If I had to say yes or no, the answer is yes. Okay. Yes, it is contagious, but there's a lot of, um, exceptions. So if you've had chickenpox or you've been vaccinated, you can't get shingles.

Jennifer: Okay.

Dr. Turegano: Or, or sorry, you can't spread shingles, but if you've never been vaccinated, um, or you're pregnant, you know, and obviously with your fetus, your fetus is not immune. So you can give someone chicken pox with shingles.

Jennifer: Oh

Dr. Turegano: Yeah. Cuz that virus is, is is in the blister fluid. So the, the spread is not the same as chickenpox. Chickenpox spreads with respiratory droplets and that's how the initial varicella zoster virus inoculates your system. But with shingles it's like living locally on the skin. So it's, it's contagious but it's harder to spread because you actually have to be more in contact with the blister fluid.

Jennifer: Got it. And so for, so you would wanna be careful maybe around like children and Exactly. Pregnant individuals,

Dr. Turegano: Pregnant people. Exactly. Yep. Mm-hmm. <affirmative>. And those are

Jennifer: The main things. If, if someone was pregnant, like are there bad, like should someone who's pregnant be worried? Like is there bad side effects that can happen if they're exposed to someone with like chickenpox or, um, shingles walls while being pregnant?

Dr. Turegano: Yeah, I would say where vearicella zoster virus does the most damage is in like a newborn baby or an unborn fetus. That's where it can actually have like the most severe impact on a human body. Um, they can be very, very sick. So, um, so, you know, it's not the end of the world like, you know, usually they're fine. It's, it's hard with shingles. Like you have to really be like in contact with the shingles, like all up on that person's skin and stuff. But I would say, you know, pregnant people should really practice caution. If, if they potentially are around anyone's shingles, they should talk to their, um, ob gyn about it if they're concerned. Okay. But it's still hard to, to get it just because like I said,

Jennifer: Yeah, I can say that now because that makes sense. This is not something that you're breathing out into the air, it's contained That's right. In something. And so unless you actually were to kind of burst the, the little sack mm-hmm. <affirmative> mm-hmm. Of the vesicle as you said mm-hmm. <affirmative>, then it's, it is a contained space. <laugh>.

Dr. Turegano: Yes. Yeah, yeah, yeah. And I typically people cause patients are like with shingles, they're like, what should I do? Like, am I contagious? And I would just say if you're gonna be out in public, like keep it covered. So if it's like, you know, if it's on your back, like you're gonna wear a shirt, no big deal. But if it's like somewhere on your arm or your face, like keep a bandage over it just so that there isn't a risk of someone getting in contact

Jennifer: You. And if it's oozing quite substantially, would that potentially be like kind of maybe a stay home situation?

Dr. Turegano: Yeah, I would say, say, so that's usually when it peaks, it's like, well, right before the vesicles, um, break that's like the peak time and then mm-hmm. <affirmative> and then, and then like once they start opening, that's actually, they're like, you're past the hump. They're still in infectious and contagious, but um, like once they start like opening, I mean they quickly scab up. So that's, you're, you're still infectious but you're, you're kind of more on the, on your way out.

Jennifer: And is this at all similar to eczema herpeticum?

Dr. Turegano: Oh yeah. So eczema herpeticum is actually related to herpes simplex. Um, so different variant, but it can look similar if eczema herpeticum is localized to one area. So in an, so eczema herpeticum is what we see typically in really, really bad cases of eczema where their eczema skin is so compromised that the herpes virus just kind of takes hostage almost of like all the eczema infected areas or eczema affected areas. And it looks like people have like these little tiny, it almost looks like punched out like little ulcers or excoriations. Um, you might, maybe you might see some blisters, but by the time I see it, everything's already like open I think cuz people, you know, it's mostly kids they're like scratching a lot. Um, so it's, it's usually kind of all over. Um, so it, it, it typically has a different presentation. Okay. But, but similar herpes family issue, so

Jennifer: Mm-hmm. <affirmative>, so similar family, but different presentation usually and, and usually a different issue. Okay. Yeah, I just wanna, I think it's good to talk about these things because Yeah. Um, especially like eczema, herpeticum, a lot of people don't even know that that's a thing. They don't realize that this can happen to them. Um, and like I said, with shingles it's sort of the same way. We don't, we're not really taught or educated mm-hmm. <affirmative> on shingles, which we really should be, because obviously time does matter in getting to the doctor and seeking treatment and, um, I, yeah, I, I had taken the, um, the Valtrex medication and definitely did not feel super great for a couple of weeks, but after that, it definitely subsided and, um, have never had an issue again. So I'm just, I'm really appreciative that you were, you were interested in coming on and talking about this topic because I feel like it's such an important kind of a public service announcement, <laugh>

Dr. Turegano: Mm-hmm. <affirmative>, but in, yeah, definitely.

Jennifer: Yeah. And in the same, in the same regard, I was saying that, you know, my audience, a lot of people are dealing with rashes and so this is kind of a rash and it looks, its, it can be confused with other, like sometimes people will think it's eczema and um, definitely it's not, it's not eczema,

Dr. Turegano: It's not, yeah. If you have like one random patch of eczema, um, and it's blistering a little bit, like that's, that's something definitely to, to see a doctor about. Um, and I, I, I'm glad, I'm so glad that you're doing this because as I'm thinking about it, I do think, you know, traditionally we thought this was like an old person disease, but I do think that it's occurring more often in younger people. I've seen it in teenagers. And it just makes you wonder what, is there something else going on in our environment that could be setting it off? So I think it's great that you're doing this because I do think that there needs to be more awareness because I feel like I've even missed a couple cases, like very early presentations in very young people. Because I'm like, no, like, it's not in my radar now. Like it's, it's more my radar. This was when I was practicing like earlier in my practice. Um, but, um, yeah, like one of 'em was like my brother-in-law. I thought he just had like infantigo on his eyebrow <laugh>, but it was herpes, um, or it was shingles. And so, um, anyways, so, so I definitely think it's important to bring awareness, so thank you for, for having this topic.

Jennifer: Yeah. And so, um, I wanna make sure that people can find you. Um, where do, do you have a physical practice that people can come and if they're looking for a dermatologist, where are you? Where do you practice at?

Dr. Turegano: I practice in the New Orleans suburb. Yeah. In Metairie, Louisiana. And the practice is called Sanova Dermatology and there's a few different sunova branches. So it's the Sanova Dermatology in Old Metairie, which is like the subsection of Metairie. And I also am very active on social media Yeah. On Instagram and TikTok. And my, my handle for that is Dr. Dot Mamina. Dr. Mamina.

Jennifer: Perfect. Well thank you so much for being here. I really appreciate it and I hope that we can do more episodes and share, um, more information with people so that they can advocate better for themselves and also know when, you know, I think this is one of those times where it's like, hey, sometimes, sometimes you can kind of figure things out yourself and sometimes mm-hmm. <affirmative>, it's better to seek help. And I think this is one of those times just because I've personally had shingles and I've also witnessed so many people in my dad's practice where it was let go too long and it got so bad. And I really appreciate you for being willing to have the conversation because Oh yeah. Shingles is not sexy.

Dr. Turegano: It's not sexy, but I weirdly like talking about it <laugh>, I love talking about vi like viruses, so <laugh>.

Jennifer: Yeah. Well thank you so much for being here and uh, I love to have you back sometime.

Dr. Turegano: Yes, please. I really enjoyed this. Thank you so much for having me.