Case history
Case history #1
A 77-year-old man reports a 5-day history of burning and aching pain on the right side of his chest. This is followed by the development of erythema and a maculopapular rash in this painful area, accompanied by headache and malaise. The rash progresses to develop clusters of clear vesicles for 3 to 5 days, evolving through stages of pustulation, ulceration, and crusting.
Case history #2
A 65-year-old woman presents with generalised headache and burning pain in her left temporal area. Eight days after onset of the pain, several facial lesions are noted. On physical examination, she is afebrile. An erythematous tender plaque is present on the left frontal scalp area. Three smaller similar plaques are present on the left temple and cheek.
Other presentations
Patients may present with pain and a unilateral rash that does not cross the midline. In most, the infection affects one dermatome. Involvement of multiple non-contiguous dermatomes is very rare in immunocompetent people but does occur in immunosuppressed people.[3] The presence of a few skin lesions outside the primary or adjacent dermatome is not unusual in immunocompetent people. Approximately 20% of patients present with systemic symptoms including fever, general body malaise, and headache.[3] Healing occurs over a period of 2 to 4 weeks, and often results in scarring and permanent pigmentation in the affected area.
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