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.
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.)