A Baby Boy With Vesicular Rash
Answers to the Questions
Answer to question 1: C
The diagnosis of neonatal varicella can be made clinically based upon the characteristic appearance of generalized vesicular skin lesions in various stages of development and healing. (picture 1)
Answer to question 2: A, B
The lesions occur in crops and are present in a variety of stages from maculopapular to vesicular or even pustule. Central necrosis and early crusting is also visible. It usually appears first on the head and then generalizes. The generalized involvement and appearances of lesions in different stages of development distinguish varicella from the vesicular rash seen in neonatal herpes simplex virus (HSV), which tends to occur in localized clusters.
Answer to question 3: E
In mild cases of neonatal varicella, the lesions heal within 7 to 10 days. However, disseminated disease may ensue, with varicella pneumonia, hepatitis, and menigoencephalitis being the most common visceral manifestations.
Answer to question 4: A, C, D
Postnatal acquired varicella in term infants > 10 days old is usually mild. Breast feeding is encouraged in newborns exposed to or infected with varicella because antibody in breast milk may be protective. Newborns with severe disseminated VZV infection (e.g pneumonia, encephalitis, thrombocytopenia, severe hepatitis) are treated with intravenous Aciclovir for 10 days. Antihistamines can be prescribed if lesions are itchy. Aspirin is contraindicated in chickenpox as it can lead to Reye Syndrome.
References
- Michael E Speer MD, Varicella –zoster infection in the newbon, Up To Date. Com, 2022, Topic 4969, Version 23.0
- American Academy of Pediatrics. Varicella-Zoster virus infections. In : Red Book 2018: Report of the committee on Infectious Diseases, 31 st ed, Junberlin DW, Brady MT, Jackson MA (Eds), American Academy of Pediatrics, 2018. P. 869.
- Dunkle LM, Arrin AM, Whitely RJ, et al. A controlled trial of acyclovir for chicken pox in normal children. N Engl J Med 1991, 325: 1539
Author Information
Hnin Thuzar Aung1, May Thet Tun2, Nu Yee Mon Aye3
- M.B.,B.S, M.Med.Sc (Paediatrics) DCH (LONDON), MRCPCH (UK), FRCP (Edinburgh), Diploma in Allergy & Asthma (C.M.C, Vellore, India), Consultant Paediatrician
- Medical Officer, Parami General Hospital
- Medical Officer, Parami General Hospital
