Shingles onset with mass under skin?


Q: Would a raised area under skin (approximately 3.5" x 1") be associated w shingles at all? Two nights ago I noticed a burning sensation on my side under my right arm, as though the skin might be raw or something similar. There was no rash or redness, just irritation of the skin surface. Sensation has persisted since then. I went to see a FNP today, concerned it cld be shingles. She noted that there is a lump/area of inflamed tissue under the skin in the area. I am not able to feel such a mass. Area is not tender to push on at all and is still not red, bruised, rash, etc. it's just a burning/raw/irritated feeling at the skin surface. She wrote an Rx for acyclovir, but instructed me not to take it unless a rash develops. Her notes (if they are helpful): "patient presents with shingles type symptoms, but also has palpable mass under skin that is not tender with palpation, located over posterior rib cage, areas about 3.5 inches in length, and mass is linear in shape with palpation; palpable mass does not appear to be a lymph node as it is outside the area of axillary lymph node chains." Blood pressure was 120/82, temp 97.7, normal pulse, etc. no other symptoms presently, though Tuesday day I was a bit achy/tired (I assumed I just hadn't slept well).

Cld this be associated with shingles onset? My understanding is that the antiviral is most helpful if taken as soon as symptoms begin. She suggested I not take the antiviral unless/until a rash actually appears, as she wasn't sure shingles was the cause, given the lump.

Anything you cld add would be appreciated.

Symptoms:  Burning/irritation of skin surface

A:   Hello. Welcome to ask the doctor.
As per details, the most likely possibility for such symptoms is shingles only. It presents as grouped vesicles over erythematous base associated with burning sensation or pain. The burning sensation or pain may preceed the vesicles also.
But the lump you have described is not associated with shingles.
I prefer to start antivirals like acyclovir / valcyclovir in such cases so as to avoid the unnecessary complications like post herpetic neuralgia. The chancea of recurrence of shingles also increase if antivirals are not adequately or appropriately take.
You can share my opinion with your doctor. I hope it helps.
Take care.

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