About 1-2 weeks after the herald patch is seen, the generalized eruption appears, although it has been known to occur from hours to 3 months later. The long axes of the lesions are oriented in a parallel fashion along lines of cleavage. This gives the classic Christmas tree pattern. These secondary lesions are most commonly found on the trunk, abdomen, back and proximal upper extremities. Lymphadenopathy is uncommon, but when present it usually is seen in African Americans.
Variable distribution can be difficult to evaluate.
Photosensitivity may occur. Photoexacerbated and photoprotected forms have been documented, although photosensitivity is not a classic manifestation of disease. Lesions may be localized to single areas such as the abdomen, groin, axilla, distal extremities, palms and soles. An inverse PR may be seen. It has lesions on the face and distal extremities and is more common in children.