There are many rashes that might look like shingles and that form part of the differential diagnosis, including other vesicular viral exanthems such as Coxsackie virus, disseminated HSV infection, pityriasis like annuities, variola forma secuta, pliva, rickettsial pox, drug eruption, scabies, and bolus insect bite reactions. Smallpox has been nearly eradicated, but also presents as widespread vesicles with distinct features. Zoster comes with diagnostic considerations, including Zostera form HSV infections that might occur of the same site, bacterial skin infections, including cellulitis and bullous impetigo. Contact dermatitis and phytophoto dermatitis caused by plants and sun exposure. With a thorough history and physical exam, the other items on the differential can be distinguished and differentiated. However, further evaluation through labs or histology may be necessary.
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