Varicella

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Background

Clinical Features

Male with varicella rash: lesions in various stages of development
Classic blister during early stage of lesion development
  • Pruritic generalized vesicular exanthem with mild systemic manifestations
  • Usually affects children <10y

Rash

  • Starts on trunk or scalp as pruritic, red macules, spreads to extremities
  • Within 24hr rash becomes vesicular (on erythematous base)
  • Palms/soles spared
  • Lesions in various stages of development

Differential Diagnosis

Pediatric Rash

Vesiculobullous rashes

Febrile

Afebrile

Varicella zoster virus

Evaluation

  • Typically made on clinical features

Management

Supportive Care

Antivirals

  • Routine use of antiretrovirals for uncomplicated cases in immunocompetent children is not recommended [1]
  • However, evidence shows decreased days of fever and number of lesions[2]

AAP recommends antiviral treatment (within 24hrs) for patients at risk of increased illness severity:

  • Any patient older than 12 years of age
  • Patients with chronic cutaneous or pulmonary disorders
  • Patients receiving long-term salicylate therapy
  • Patients receiving short, intermittent, or aerosolized courses of corticosteroids

Other cases to consider acyclovir

  • Also consider in [3]:
  • Pregnancy[4]

Immunocompetent Adult

Immunocompromised Adult

At risk children <12yo child based on AAP criteria

Disposition

Vaccine

  • Introduced in 2006. Prior to introduction, incidence prior to adolescence approached 90% in US
  • Vaccine is 85% effective against all disease, 90% effective against severe disease (greater than 1000 lesions)
  • Typically given at age 5 in USA

Complications

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

See Also

Pediatric Rashes

References

  1. Arvin AM: Antiviral therapy for varicella and herpes zoster. Semin Pediatr Infect Dis 2002; 13:12.
  2. Klassen TP, et al. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev. 2005; (4):CD002980.
  3. Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.
  4. CDC Chicken pox acyclovir treatment [1]