Varicella zoster virus (VZV) causes both chickenpox, the primary illness, and herpes zoster, which follows reactivation of the virus in the nerve ganglia. In zoster, pain, fever, and malaise may occur before erythematous papules develop in the area of the affected dermatome—most commonly in the thoracic area. Vesicles develop over several days, crusting over as they resolve. Secondary bacterial infection is common. Some patients develop episodes of pain in the affected area—postherpetic neuralgia after clearance of the rash. Skin lesions and nasopharyngeal secretions can transmit chickenpox.
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