A pruritic, erythematous rash developed in a 6-year-old boy over the previous 5 days. The rash erupted in crops; the lesions appeared initially as rose-colored macules, progressed rapidly to papules and vesicles, and finally crusted. The distribution of the lesions-with the greatest concentration on the trunk-is typical of chickenpox.
A pruritic, erythematous rash developed in a 6-year-old boy over the previous 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.
Drs Alexander K. C. Leung and Matthew C. K. Choi of Calgary, Alberta, point out that postinflammatory scarring may result from chickenpox (B). They suggest symptomatic relief of itching 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.1,2
Drs Leung and Choi caution that 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.
Impetigo secondary to chickenpox is seen on the face of a 7-year-old boy (C). Robert P. Blereau, MD of Morgan City, La, treated the youngster's condition with oral cephalexin and mupirocin ointment for 10 days, and the infection resolved promptly.
Erythema caused by cellulitis secondary to chickenpox is seen on the right anterior chest of this 10-month-old girl (D). A small abscess formed at the center of the erythema and drained spontaneously. The disease resolved following a 3-week course of oral cephalexin.
Dr Blereau notes that as many as 10,000 children and adolescents are hospitalized each year because of chickenpox and its complications, and 43 of these youngsters die.3 He advocates wider use of the chickenpox vaccine to prevent the disease and secondary infections.
REFERENCES:1. Leung AK, Robson WL. Chickenpox: an update. Update: J Continuing Ed Gen Pract. 1994;49:227-286.
2. Huston RL, Cypcar D, Cheng GS, Fouls DM. Toxicity from topical administrationi of diphenhydramine in children. Clin Pediatr (Phila). 1990;29:542-545.
3. Centers for Disease Control and Prevention. Varicella-related deaths among children-United States, 1997. MMWR. 1998;47:365-368.