The hallmark of zoster (girdle in Greek) is its clustered pattern, as opposed to the nonclustered pattern of
varicella. The rash is usually preceded by paresthesia and pain in the involved dermatome (Saint Anthony’s
fire). This is often mistaken as musculoskeletal, due to its intensity and deep location. Hence, zoster should
always be considered in patients with deep dermatomal pain with no historical or physical explanations. The
prodromal discomfort is then followed by the appearance of erythematous plaques, which, in sequence, develop into (1) grouped vesicles, (2) pustules, (3) umbilicated pustules, and (4) crusts. The
rash is unilateral, does not cross the midline, and generally appears in only one dermatome, with
trigeminal and T3 to L2 being the most common. It is not unusual to see a few vesicles just outside the
involved dermatome
varicella. The rash is usually preceded by paresthesia and pain in the involved dermatome (Saint Anthony’s
fire). This is often mistaken as musculoskeletal, due to its intensity and deep location. Hence, zoster should
always be considered in patients with deep dermatomal pain with no historical or physical explanations. The
prodromal discomfort is then followed by the appearance of erythematous plaques, which, in sequence, develop into (1) grouped vesicles, (2) pustules, (3) umbilicated pustules, and (4) crusts. The
rash is unilateral, does not cross the midline, and generally appears in only one dermatome, with
trigeminal and T3 to L2 being the most common. It is not unusual to see a few vesicles just outside the
involved dermatome
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