What are the symptoms of herpes zoster (shingles) following the prodromal phase?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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After the onset of prodromal symptoms, the following signs and symptoms occur:

  • 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)

  • Pain in the dermatomal area of involvement may remain the same as in prodrome or may change in character and intensity with the onset of other symptoms; many patients describe the pain as burning, throbbing, or stabbing in nature; it may be severe, mild, constant, rare, or felt as another sensation such as pruritus; the involved area may be tender to palpation [1]

  • Vesicular involution – Vesicles initially are clear but eventually cloud, rupture, crust, and involute, a process that may be greatly accelerated by treatment

  • After vesicular involution, slow resolution of the remaining erythematous plaques, typically without visible sequelae – Note, however, that scarring can occur if deeper epidermal and dermal layers have been compromised by excoriation, secondary infection, or other complications

Unfortunately, resolution of the associated pain does not always accompany resolution of erythema and vesiculation. Postherpetic neuralgia (PHN), which usually is confined to the area of original dermatomal involvement, can persist for weeks, months, or years and is often severe. Severe prodromal pain and the density of the herpetic eruption have been characterized as risk factors and predictors for PHN. [56]

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