Varicella

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Varicella is now much less common with universal varicella vaccination of children. Occasionally the family physician sees a case of breakthrough chickenpox in a vaccinated child. Unvaccinated adults may also present with varicella. Patients with varicella have fever and general malaise as a mild prodrome lasting 1 to 2 days before the rash appears. The rash typically begins on the face, scalp, or trunk and then spreads to the extremities. The lesions appear as erythema-tous macules and progress to papules with an edematous base. The papules quickly evolve into vesicles, appearing as "dewdrop on a rose petal" (Fig. 33-15). The vesicles evolve into pustules, which become umbilicated and subsequently crust over in the ensuing 8 to 12 hours. A defining characteristic of varicella is that lesions may be present in all stages simultaneously.

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Figure 33-14 Acne conglobata. (e Richard P. Usatine.)

Figure 33-14 Acne conglobata. (e Richard P. Usatine.)

Figure 33-15 Chickenpox. (e Richard P. Usatine.)

In children the most common varicella complication is secondary bacterial infection of excoriated lesions. Other complications include cerebellar ataxia, encephalitis, meningitis, transverse myelitis, and rarely Reye's syndrome. Varicella pneumonia and encephalitis can be serious complications in adults. Because of the risk of Reye's syndrome, aspirin use should be avoided in patients with varicella. Acy-clovir is recommended for adolescents, adults, and children with varicella who are taking steroids or otherwise immuno-compromised.

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