Clinical manifestation

May begin with non-specific constitutional symptoms and signs; prodromal pain or parathesias along one or more der-matomes, lasting i-i0 days, followed by patchy erythema in the dermatomal area of involvement and regional lymphadenopa-thy; unilateral, grouped vesicles on ery-thematous base, with severe local pain; vesicles initially clear, but eventually becoming pustular, rupturing, crusting, and involuting; scarring ensues if deeper epidermal and dermal layers compromised by scratching, secondary infection, or other complications

Zoster oticus (geniculate zoster, zoster auris, Ramsay-Hunt syndrome, Hunt syndrome): Meniere disease, Bell palsy, cer-brovascular accident or abscess of the ear; beginning with otalgia and herpetiform vesicles on the external ear canal, with or without features of facial paralysis, resulting from facial nerve involvement, auditory symptoms (e.g., deafness), and vestibular symptoms

Disseminated zoster: generalized eruption of more than i5-25 extradermatomal vesicles, occurring 7-i4 days after the onset of dermatomal disease; occurs rarely in the general population, but commonly in elderly, hospitalized, or immunocompromised patients; often an indication of depressed cell-mediated immunity caused by various underlying clinical situations, including malignancies, radiation therapy, cancer chemotherapy, organ transplants, and chronic use of systemic corticosteroids; dissemination sometimes includes involvement of the lungs and central nervous system

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