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Atypical primary varicella rash: Systematic literature review
Author(s) -
Mazzara Calogero,
Milani Gregorio Paolo,
Lava Sebastiano A. G.,
Bianchetti Mario Giovanni,
Gualco Gianluca,
Simonetti Giacomo D.,
Camozzi Pietro,
Kottanattu Lisa
Publication year - 2022
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.16300
Subject(s) - medicine , rash , dermatology , chickenpox , pediatrics , immunology , virus
Aim In previously healthy subjects, primary varicella presents with a distinctive vesicular rash that is more intense on the trunk and head than on the extremities. However, an atypical presentation may occasionally develop. We aimed at systematically assessing the characteristics of cases affected by atypical primary varicella rash. Methods The United States National Library of Medicine, Excerpta Medica and Web of Science databases were reviewed, without date or language restrictions. Articles were eligible if reporting previously healthy and immunocompetent subjects with a primary varicella rash (i.e., a photo‐localised primary varicella or skin inflammation‐associated primary varicella). Results Thirty‐eight reports providing information on 59 cases of atypical primary varicella were identified. Twenty‐four cases (median 8.5 years of age, 19 females) were photo‐localised and 35 (median 4.8 years of age, 15 females) were associated with pre‐existing skin inflammation (including cast occlusion, diaper irritation, operative sites, burns, insect bites, vaccinations or pre‐existing skin disease). The skin rash was monomorphic and without a “starry sky” appearance. Conclusion Primary varicella may have a modified presentation in areas of irritation such as sun exposure or pre‐existing inflammation. There is a need for a wider awareness of these modulators of varicella rash.