Red-ringed blisters occur in a dermatomal distribution of a nerve root. Papules change to vesicles which become pustules before crusting. New lesions appear for up to one week. Regional lymph glands may be tender and swollen. Since this is primarily a nerve infection with secondary skin manifestations, it is preceded, accompanied, and followed by pain.
In elderly patients, it is often severe and prolonged. In immunosuppressed patients, herpes zoster may disseminate, producing lesions beyond the dermatome, visceral lesions, and encephalitis. Disseminated Zoster is a serious, sometimes life-threatening complication.