The patch is characterized as oval or round with a central, wrinkled, salmon-colored area and a dark red peripheral zone. The areas are separated by a collarette of fine scales. The herald patch usually is located on the trunk but can be seen on the neck or extremities. The secondary eruption appears at its maximum in about 10 days. The secondary eruption is symmetric and localized, predominantly to the trunk and adjacent areas of the neck and extremities.
Involvement is maximal over the abdomen and anterior and dorsal surfaces of the thorax.
The secondary lesions appear as the primary patch in miniature, with the two red zones separated by the scaling ring. They are distributed with their long axes following the lines of cleavage of the skin in a Christmas tree pattern. The distribution of the rash may be peripheral, and facial involvement may be seen in children. Hypopigmentary and hyperpigmentary skin changes may follow the inflammatory stage. In patients with black skin, hyperpigmentation is more common.