During this prodromal period, patients may present with symptoms consistent with acute myocardial infarction, urolithiasis, pleurisy, trigeminal neuralgia, appendicitis, cholelithiasis, or herniated nucleus pulposus with radiculopathy, depending upon the involved dermatome. The most commonly involved dermatomes are those of the thorax. Pain may or may not subside. Pain lasting longer than 1 month is referred to, by definition, as postherpetic neuralgia. Zoster cine herpete is defined as pain and paresthesias along the dermatome without the development of visible cutaneous involvement.
Bilateral rash is rare.
Zoster lesions occur simultaneously and remain in congruent stages of healing. In the ED, diagnosis of herpes zoster is based primarily on clinical findings. Patients with herpes zoster usually experience severe pain. In many cases, narcotic analgesia is necessary. Acyclovir antivirals may decrease incidence of postherpetic neuralgia.