Atypical Varicella Exanthems Associated With Skin Injury

varicella is a common childhood disease with a typical exanthem. We present four children with severe, localized disease, all associated with some form of trauma to the skin during the incubation period: a 3½‐year‐old boy sustained wasp stings on the hand, a 5‐year‐old boy received extensive sun exposure, a neonate had latrogenic trauma to her arm, and a 13‐year‐old boy underwent knee arthroscopy and was wearing a cast. It is postulated that such injuries to the skin either allowed more virus‐infected cells to enter the skin at the sites, or that factors such as insect venom and ultraviolet light altered local immunity to varicella zoster virus.