Chickenpox in a Child

February 1, 2002
David L. Kaplan, MD
David L. Kaplan, MD

A pruritic, erythematous rash developed in a 6-year-oldboy over 5 days. The rash erupted in crops; the lesions appearedinitially as rose-colored macules, progressed rapidlyto papules and vesicles, and finally crusted (A). The distributionof the lesions-with the greatest concentrationon the trunk-is typical of chickenpox.

A pruritic, erythematous rash developed in a 6-year-oldboy over 5 days. The rash erupted in crops; the lesions appearedinitially as rose-colored macules, progressed rapidlyto papules and vesicles, and finally crusted (A). The distributionof the lesions--with the greatest concentrationon the trunk--is typical of chickenpox.Postinflammatory scarring may result from chickenpox(B).1 Symptomatic relief of itching can be obtained withtopical antipruritic agents, such as those containing pramoxineand menthol, and with hydroxyzine hydrochlorideor another systemic antihistamine. Because of its associationwith toxic encephalopathy in patients with chickenpox,topical or oral diphenhydramine is not recommended.2,3Meticulous attention to hygiene is necessary to preventsecondary bacterial infections, which require topicalor systemic antibiotic therapy. Such secondary infectionsare impetigo and cellulitis.

References:

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 administrationof 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.)