The classic presentation is one or several oval red plaques confined to one, two or three adjacent dermatomes. Vesicles then appear on the surface.
The vesicles may vary in size in contrast to the vesicles of herpes simplex infections in which the vesicles are all uniform in size. The vesicles umbilicate and eventually dry, cross and heal. It is not uncommon to find single vesicles scattered throughout the body on the trunk and extremities.
The intensity of the infection may be so severe that the entire dermatome is involved. Most infections well heal without scarring. Cases in which there is severe involvement may yield with scars of varying configuration. The scarring pattern is often typical enough so that clinicians years later will suspect a past history of herpes zoster infection.
Occasionally patients will have all of the prodromal symptoms but never developed the rash.