How is the acute eruptive phase of herpes zoster (shingles) characterized?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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The acute eruptive phase is marked by the following:

  • Patchy erythema, occasionally accompanied by induration, in the dermatomal area of involvement

  • Regional lymphadenopathy, either at this stage or subsequently

  • Grouped herpetiform vesicles developing on the erythematous base (the classic finding)

  • Cutaneous findings that typically appear unilaterally, stopping abruptly at the midline of the limit of sensory coverage of the involved dermatome

  • Vesicular involution: Vesicles initially are clear but eventually cloud, rupture, crust, and involute

  • After vesicular involution, slow resolution of the remaining erythematous plaques, typically without visible sequelae

  • Scarring can occur if deeper epidermal and dermal layers have been compromised by excoriation, secondary infection, or other complications

  • Almost all adults experience pain, typically severe

  • A few experience severe pain without a vesicular eruption (ie, zoster sine herpete)

  • Symptoms tend to resolve over 10-15 days

  • Complete healing of lesions may require up to a month

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