Diagnosis

Both chickenpox (varicella) and shingles (zoster) can usually be diagnosed using symptoms alone. If a diagnosis is still unclear after a physical examination, then diagnostic tests may be required.

Ruling Out Other Disorders

Either variation of the virus may be confused with other disorders.

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Ruling out Disorders that Resemble Chickenpox. Chickenpox, particularly in early stages, may be confused with herpes simplex (the disorder more commonly referred to as "herpes"), or impetigo, insect bites, and scabies.

Ruling out Disorders that Resemble Shingles. The early prodrome stage of shingles can cause severe pain on one side of the lower back, chest, or abdomen before the rash appears. It therefore may be mistaken for disorders, such as gallstones, that cause acute pain in internal organs.

In the active rash stage, shingles may be confused with herpes simplex, particularly in young adults and if the blisters occur on the buttocks or around the mouth. Herpes simplex, however, does not usually generate chronic pain.

A diagnosis may be difficult if herpes zoster takes a non-typical course, such as with Bell's palsy or Ramsay Hunt syndrome in the face, or if it affects the eye, or causes fever and delirium.

Test to Identify the Virus

In most cases of chickenpox and shingles, the symptoms alone are sufficient to make a diagnosis. In some patients, such as those who are immunosuppressed, if the symptoms are not straightforward the physician performs one or more additional tests to detect the virus itself. They are usually performed to distinguish between varicella-zoster and herpes simplex viruses.

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