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INTRODUCTION

KEY POINTS

  • Herpes simplex and varicella zoster both present with vesicular and papular morphologies that are often clustered and can become secondarily impetiginized.

  • In lighter skin, this is often bright pink to red and can become darker centrally as it resolves.

  • In darker skin, this can appear red to red-brown, violaceous, or skin-colored. Resolution in darker skin at the base of the vesicles is often dark brown.

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ECZEMA HERPETICUM

FIGURE 16-1.

Pink monomorphic eroded papules densely scattered on the lateral face, with impetiginization visible along the ear. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 8-22.)

FIGURE 16-2.

Pink-red eroded impetiginized papules densely scattered on the right side of the face. Note the amount of visible erythema surrounding each of these papules, which is less visible in the person with skin of color. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 7-6).

HERPES SIMPLEX

FIGURE 16-3.

Pink clustered vesicles and pustules on an erythematous base of the left buttock representing active herpes simplex virus (HSV) infection. Superior to this are areas of resolving HSV infection, visible by the crusted violaceous papules surrounded by postinflammatory hyperpigmentation. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 135-11. Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 16-4.

Pink grouped vesicles with central erosions and crusting in the perioral region of the face. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 5-36.)

VARICELLA ZOSTER

FIGURE 16-5.

Light-brown to violaceous pinpoint vesicles coalescing into plaques, with a mild background of subtle pink erythema clustered along the thoracic dermatome. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 7-8.)

FIGURE 16-6.

Bright-pink grouped vesicles coalescing into plaques with an intensely visible background of erythema. (Reproduced with permission from Burgin S, et al. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 2-41.)

FIGURE 16-7.

Multiple plaques of grouped vesicles on an erythematous base extending along the thoracic dermatome. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, ...

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