Grouped vesicles on an erythematous base are seen in the distribution of the first division of the trigeminal nerve. Note that the lesions do not cross the midline. Tzanck smear demonstrates several multinucleated giant cells, a characteristic finding in herpes infections. Although not specific for herpes zoster, it confirms the diagnosis in the proper clinical context. Same patient after three days of intravenous acyclovir therapy.
Significant improvement is manifested by crusting and drying of the lesions.
In the immunocompromised host, lesions occur with increased frequency and severity and are more likely to be multidermatomal, recurrent or chronic.