What are the signs and symptoms of the acute eruptive phase of herpes zoster (shingles)?

Updated: Jan 25, 2019
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

The acute eruptive phase is marked by the emergence of vesicular eruptions. Patients may also experience some of the other symptoms seen in the preeruptive phase. Lesions begin as erythematous macules and papules that quickly develop into vesicles. New lesions tend to form over a period of 3-5 days, sometimes coalescing to form bullae. After they form vesicles, lesions progress through stages in which they rupture, release their contents, ulcerate, and finally crust over and become dry. Patients remain infectious until the lesions have dried.

During this phase, almost all adult patients experience pain (ie, acute neuritis). A few experience severe pain without any evidence of a vesicular eruption (ie, zoster sine herpete), and a small number have a characteristic eruption but do not experience pain. Symptoms and lesions in the acute eruptive phase tend to resolve over 10-15 days. However, lesions may require up to a month to completely heal, and the associated pain may become chronic.


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