Dermatologic Physical Exam

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Primary Lesions

1. Erythematous urticarial plaque or plaques within a dermatome segment or contiguous dermatomes (see Photo 21).

2. Grouped 3- to 5-mm vesicles that evolve and often umbilicate (see Photo 22).

3. Pustules that replace vesicles as the lesions mature (see Photo 23).

Secondary Lesions

1. Erosions as blisters and pustules rupture (see Photos 16,19).

2. Crusting as pustules dry and shrink or due to secondary infection (see Photos 16,19).

3. Hemorrhage into vesicles (see Photo 20).

4. Necrosis and gangrene in severe lesions having an active vascular component (see Photo 15).

5. Postinflammatory hyperpigmentation, common even in uncomplicated zoster.

6. Scarring, more common in older patients or in zoster that is associated with underlying systemic disease.

Distribution

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