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. 2022 May;111(5):935-939.
doi: 10.1111/apa.16300. Epub 2022 Feb 27.

Atypical primary varicella rash: Systematic literature review

Calogero Mazzara  1 , Gregorio Paolo Milani  2   3 , Sebastiano A G Lava  4 , Mario Giovanni Bianchetti  5 , Gianluca Gualco  1 , Giacomo D Simonetti  1   6 , Pietro Camozzi  5 , Lisa Kottanattu  1   6
Affiliations

Atypical primary varicella rash: Systematic literature review

Calogero Mazzara et al. Acta Paediatr. 2022 May.

Abstract

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.

Keywords: atypical rash; chickenpox; primary varicella; varicella.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Atypical varicella. Selection process for articles included in the systematic review
FIGURE 2
FIGURE 2
Distribution of photo‐localised varicella rash occurring after recent sun exposure in 24 patients. The total number indicated in the figure exceeds the number of patients because more than one localisation was observed in some patients
See this image and copyright information in PMC

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