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 syndrome)
• Routine use of antiretrovirals for uncomplicated cases in immunocompetent children is not recommended (Tintinallli 7th ed)
• Immunocompromised: IV acyclovir or high-dose PO tx (600mg/m2/day)

Complications

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

See Also

Pediatric Rashes