Herpes zoster physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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Physical Examination

People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. The rash does not usually cross the body’s midline. However, approximately 20% of people have rash that overlaps adjacent dermatomes. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster. This generally occurs only in people with compromised immune systems. Disseminated zoster can be difficult to distinguish from varicella.

The rash develops into clusters of clear vesicles. New vesicles continue to form over three to five days and progressively dry and crust over. They usually heal in two to four weeks. There may be permanent pigmentation changes and scarring on the skin.

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  Dermatomal involvement of rash
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  Dermatomal involvement of skin rash
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  Herpes zoster on the chest
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  Varicella zoster

(Images shown below courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

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  Herpes Zoster: Coalesced vesicles resulting from reactivation of HZV infection.
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  Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.
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  Herpes Zoster: Dermatomally distributed vesicles in patient with HZV infection.
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  Herpes Zoster: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.
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  Shingles on waist

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  Herpes Zoster.
  (Courtesy of Josh Fierer, M.D. and Charlie Goldberg, M.D.)
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  Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.
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  Herpes Zoster C3 Distribution: Dermatomally distributed vesicles, many of which have coalesced, in patient with HZV infection.
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  Shingles on face
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  Shingles on face

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  Child with shingles who had a history of leukemia
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  Plantar foot rash caused by herpes zoster
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  Vesicular lesions of Herpes zoster
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  The pathologic changes seen on the surface of the right unilateral side of this elderly male patient’s tongue and chin, represent a herpes outbreak due to the Varicella zoster virus (VZV) pathogen.
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  The pustulo-vesicular rash on this African-American woman’s face, represents a herpes outbreak due to the Varicella zoster virus (VZV) pathogen.

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  This 1968 image depicted a number of varicella, or chickenpox lesions on a patient’s back, which were displaying the characteristic “cropping” distribution, or manifesting themselves in clusters, each in a different developmental stage.
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  This patient presented with what was differentially diagnosed as a herpes zoster outbreak in order to rule out syphilis.
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  This skin disorder was found to be herpes zoster, not syphilitic in nature as was initially suspected.
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  These skin lesions on the forehead of an elderly woman are due to the herpes zoster virus on the 21st day of the illness.
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  A case of shingles that demonstrates the typical dermatomal distribution, in this case C8/T1