Typical presentation of Herpes Zoster (Shingles)

Note the typical dermatomal pattern and its unilaterality. The lesion is typically painful and the pain actually precedes the appearance of the rash by a few days.   Below is a patient who has shingles but not the characteristic findings. Tzanck smear can be done but in most patients the diagnosis is clinical.

Herpes zoster - Atypical (Shingles)

This is certainly not a good picture. Nevertheless, patients may recall having had chicken pox in the remote past. This eruption that takes place years after having had chicken pox is often triggered by seasonal, emotional or health stress.

Patients complain about burning/pain at the site. Treatment of choice is Acyclovir/Famciclovir/Valacyclovir if the attacks are recurrent.
Valacyclovir is not safe in AIDS patients.

Post-herpetic neuralgia is a bothersome complication and its incidence in the future is reduced by giving Nortryptiline and prednisone. 

Healing zoster looks like the picture below