Varicella

Background

• Caused by varicella zoster virus causing varicella (chicken pox) and later zoster (Shingles)
• Contagious until last lesion crusts over

Diagnosis

Male with varicella rash: lesions in various stages of development

Classic blister during early stage of lesion development

• Pruritic generalized vesicular exanthem w/ mild systemic manifestations
• Usually affects children <10y
• Rash
  • Starts on trunk or scalp as pruritic, red macules, spreads to extremities
  • W/in 24hr rash becomes vesicular (on erythematous base)
  • Palms/soles spared
  • Lesions in various stages of development

Differential Diagnosis

Pediatric Rash

• Atopic dermatitis
• Bed bugs
• Contact dermatitis
• Drug rash
• Erythema infectiosum (Fifth disease)
• Hand-foot-and-mouth disease
• Henoch-schonlein purpura (HSP)
• Herpangina
• Herpes simplex virus (HSV)
• Infectious mononucleosis
• Meningitis
• Measles
• Molluscum contagiosum
• Roseola infantum
• Rubella (German measles)
• Scabies
• Scarlet fever
• Smallpox
• Varicella (Chickenpox)

Treatment

• Tylenol, antihistamine, oatmeal baths
  • No Aspirin (may predispose to Reye's Syndrome)
• Routine use of antiretrovirals for uncomplicated cases in immunocompetent children is not recommended in Tintinallli 7th ed
• However, evidence shows decreased days of fever and number of lesions
  • Consider Acyclovir20 mg/kg (up to 800 mg) PO q6hrs x 5 days for children >12 y/o
• Immunocompromised:
  • ≤12 yrs - Acyclovir 20 mg/kg IV q8hrs x 7-10 days
  • >12 yrs - Acyclovir 10 mg/kg IV q8hrs x 7 days

Complications

• Can include encephalitis, pneumonia, hepatitis, strep/staph superinfection of ruptured vesicles
• Perinatal infection in neonates may develop serious illness

See Also

Pediatric Rashes