Dermatology - Chickenpox
Varicella zoster virus (VZV), sometimes known as chickenpox, infection VZV is a human herpes virus that is spread through the air by tiny droplets and through direct contact between people. It is typically indicative and predominantly manifests throughout childhood. Following the initial infection, VZV forms a persistent infection in sensory ganglia, leading to lifelong infection. Recurrences of the illness, known as herpes zoster, occur when the immune response weakens. The VZV vaccine has significantly decreased the occurrence of both varicella and herpes zoster. The initial skin abnormalities appear on the face and head, then extend downwards to the trunk and limbs. They are most abundant in regions that are least subjected to pressure, such as the areas between the shoulder blades, flanks, armpits, and the bends of the knees and elbows. The palms and soles are typically unaffected. Children may experience central nervous system (CNS) involvement, including cerebellar ataxia, encephalitis, and Reye syndrome. Respiratory problems are frequently experienced by adolescents and adults. Abnormalities The primary skin abnormalities are small raised bumps (often not visible) that may manifest as swollen, itchy areas and rapidly progress to fluid-filled blisters, which are shallow and delicate, accompanied by redness in the surrounding area. The vesicles undergo rapid transformation into pustules and crusted erosions within a span of 8 to 12 hours. During following crop cycles, it is possible to observe all stages of evolution simultaneously, namely papules, vesicles, pustules, and crusts, which collectively exhibit polymorphism. Crusted erosions often undergo healing within a period of 1 to 3 weeks, resulting in the formation of a pink, somewhat sunken base. Distinctive indentations that are caused by punching and are long-lasting may remain. One may see oropharyngeal vesicles and subsequent erosions, especially on the palate. The diagnosis is determined through clinical examination and validated by conducting specific tests such as direct fluorescent antibody (DFA) test, Tzanck smear, serology, or dermatopathology, as required. The differential diagnosis comprises disseminated herpes simplex virus (HSV) infection, cutaneous dissemination of zoster, eczema herpeticum, rickettsia pox, and enterovirus infections. Manage pruritus by using antihistamines and lotions. Refrain from using antipyretics as they have a risk of causing Reye syndrome. To reduce the severity of the illness, antiviral drugs should be administered within 24 hours of the symptoms appearing. For infants, valaciclovir should be given at a dose of 20 mg/kg every 8 hours for five days, or acyclovir at a dose of 20 mg/kg every 6 hours for 5 days. Adolescents and adults should take valaciclovir at a dose of 1 g every 8 hours for 7 days. For those with weakened immune systems, the recommended dosage is 1 gram of valaciclovir every 8 hours for a duration of 7 to 10 days. Alternatively, acyclovir can be taken at a dosage of 800 milligrams five times a day, or famciclovir can be taken at a dosage of 500 milligrams every 8 hours for the same duration. Administer intravenous acyclovir or foscarnet to those with severe immunocompromise.
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