Herpes zoster

The classic presentation is one or several oval red  plaques confined to one, two or three adjacent dermatomes. Vesicles then appear on the surface.

herpes-zoster

A classic presentation of shingles showing vesicals in groups confined to a dermatome. A dermatome is a section of skin supplied by a single nerve.

herpes-shingles

Shingles involving two adjacent dermatomes. This is a common occurrence.

shingles-zoster

Shingles can involve any skin area of the body. This case was misdiagnosed as poison ivy.

shingles-body

Shingles involving the groin area

 

shingles-face

Shingles involving the face is a common occurance

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.

shingles-skin

Shingles begins with vesicals in a group. The size of the vesicals varies in shingles. The size of the vesicals in herpes simplex does not vary.

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.

herpes-zoster-shingles

A severe case of shingles involving the entire skin surface of a dermatome

Occasionally patients will have all of the prodromal symptoms but never developed  the rash.