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Chickenpox in a Child

Chickenpox in a Child

A pruritic, erythematous rash developed in a 6-year-old boy over 5 days. The rash erupted in crops; the lesions appeared initially as rose-colored macules, progressed rapidly to papules and vesicles, and finally crusted (A). The distribution of the lesions--with the greatest concentration on the trunk--is typical of chickenpox. Postinflammatory scarring may result from chickenpox (B).1 Symptomatic relief of itching can be obtained with topical antipruritic agents, such as those containing pramoxine and menthol, and with hydroxyzine hydrochloride or another systemic antihistamine. Because of its association with toxic encephalopathy in patients with chickenpox, topical or oral diphenhydramine is not recommended.2,3 Meticulous attention to hygiene is necessary to prevent secondary bacterial infections, which require topical or systemic antibiotic therapy. Such secondary infections are impetigo and cellulitis.


REFERENCES: 1. Leung AK, Kao CP, Sauve RS. Scarring resulting from chickenpox. Pediatr Dermatol. 2001;18:378-380.
2. Leung AK, Robson WL. Chickenpox: an update. Update: J Continuing Ed Gen Pract.1994;49:227-286.
3. Huston RL, Cypcar D, Cheng GS, Foulds DM. Toxicity from topical administration of diphenhydramine in children. Clin Pediatr (Phila). 1990;29:542-545. (Case and photographs courtesy of Drs Alexander K. C. Leung and Matthew C. K. Choi.)
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