A 44-year-old Hispanic man presents for evaluation of a rash of 2 days’ duration. Lesions originated on his face and rapidly spread to his trunk, back, and upper extremities. When the rash began, he had a fever of 101° F. The patient states that the rash is very itchy. His immunization status is unknown. Physical examination reveals disseminated vesicular lesions with surrounding erythema of the affected areas along with crusted papules.
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Varicella (chicken pox) is caused by the varicella zoster virus (VZV). Patients typically present with successive occurrences of pruritic disseminated vesicles with surrounding erythema. About 90% of cases of VZV occur in unvaccinated individuals younger than age 10; however, it can present at any age. The route of transmission is through airborne droplets and direct contact with the highly contagious virus.1
Diagnosis is primarily clinical and may be confirmed by viral culture and PCR. The initial vesicular lesions progress to crusted erosions that typically heal in 1 to 3 weeks, infrequently leaving a “punched-out” scar. Antiviral medications such as acyclovir or valaciclovir are recommended to reduce complications in adolescents and adults; treatment is not recommended for otherwise healthy children.1,2 Antiviral therapy can decrease the severity of the disease if given within the first 24 hours of onset.
The varicella vaccine was first developed in 1970 and is one of the most effective and safest vaccines available. People who have been vaccinated may still get the disease; however, it is usually a milder form.3 Children should be vaccinated between 12 and 15 months and again between 4 and 6 years of age.4
Dr Schleicher is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at the Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College. Lauren Ax is a physician assistant student at Kings College in Wilkes Barre, PA.
- Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York: McGraw-Hill Education; 2013.
- Soman R, Madan S. Chickenpox: docile or deadly? J Postgrad Med. 2013;59:91-92.
- Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older, United States. 2013. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a3.html
- Centers for Disease Control and Prevention (CDC). Chickenpox (varicella). 2016. Retrieved from https://www.cdc.gov/chickenpox/vaccination.html