Eczema vaccinatum

8 month old with eczema vaccinatum after acquiring vaccinia from a sibling recently vaccinated for smallpox.
Specialty| Infectious disease
Symptoms| Crops of small blisters, fever, swollen glands[1]
Complications| Scarring[2]
Usual onset| Sudden, 5 to 12 days post exposure[1][3]
Causes| Vaccinia[2]
Risk factors| Atopic dermatitis, other skin diseases[2]
Differential diagnosis| Eczema herpeticum, chickenpox, bacterial superinfection[4][3]
Treatment| Vaccinia immune globulin (VIG), antivirals[2]
Frequency| Rare[1][4]
Deaths| 35% without treatment, 7% with treatment[2]

Eczema vaccinatum is a type of vaccinia infection, that may occur in people with atopic dermatitis (eczema) or other skin diseases.[2] Symptoms include a sudden onset of crops of small blisters, typically at sites of skin problems.[2] Typically there is also a fever and swollen glands.[1][5] Onset is 5 to 12 days post exposure.[3]

While it may occur due to direct smallpox vaccination with vaccinia; more often it occurs following spread from a household member who has had a recent vaccine.[2] While atopic dermatitis is a risk factor for the disease; it is estimated that if vaccinated, only one in a hundred would be affected.[4] The underlying mechanism involves extensive spread of the virus.[4] Diagnosis is usually based on exposure to vaccinia.[6]

Treatment is with vaccinia immune globulin (VIG) and potentially the antiviral medication cidofovir.[2][4] Prevention may include the use of the MVA-BN vaccine in those at high risk.[4] Scarring often remains after healing.[2] Without treatment around 35% die, and with treatment this is about 7%.[2]

Between 2002 and 2012 only one case was described in the United States.[4] In the United States in 1968 there were 66 cases following 14.5 million smallpox vaccinations, and 60 cases among several million contacts.[1] Males are affected twice as often as females.[3] The condition is believed to have been first described in 1882.[4]

## Contents

* 1 Signs and symptoms
* 2 Diagnosis
* 2.1 Differential diagnosis
* 3 Treatment
* 4 See also
* 5 References
* 6 External links

## Signs and symptoms[edit | edit source]

It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin in people with previous diagnosed skin conditions such as eczema or atopic dermatitis, even if the conditions are not active at the time. Other signs and symptoms include fever and facial and supraglottic edema. The condition may be fatal if severe and left untreated. Survivors are likely to have some scarring (pockmarks).

Smallpox vaccine should not be given to patients with a history of eczema. Because of the danger of transmission of vaccinia, it also should not be given to people in close contact with anyone who has active eczema and who has not been vaccinated. People with other skin diseases (such as atopic dermatitis, burns, impetigo, or herpes zoster) also have an increased risk of contracting eczema vaccinatum and should not be vaccinated against smallpox.

## Diagnosis[edit | edit source]

A culture of vesicular fluid will grow vaccinia virus. Skin biopsy shows necrotic epidermal cells with intranuclear inclusions.

### Differential diagnosis[edit | edit source]

Eczema is also associated with increased complications related to other vesiculating viruses such as chickenpox; this is called eczema herpeticum.

## Treatment[edit | edit source]

Eczema vaccinatum is a serious medical condition that requires immediate and intensive medical care. Therapy has been supportive, such as antibiotics, fluid replacement, antipyretics and analgesics, skin healing, etc.; vaccinia immune globulin (VIG) may be useful but supplies are deficient as of 2006. Antiviral drugs have been examined for activity in pox viruses and cidofovir is believed to display potential in this area.[7][8]

## See also[edit | edit source]

* List of cutaneous conditions

## References[edit | edit source]

1. ↑ 1.0 1.1 1.2 1.3 1.4 Petersen, Brett W.; Damon, Inger K. (2020). "348. Smallpox, monkeypox and other poxvirus infections". In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine. Vol. 2 (26th ed.). Philadelphia: Elsevier. p. 2183\. ISBN 978-0-323-53266-2.
2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "19. Viral diseases". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. pp. 387–388. ISBN 978-0-323-54753-6. Archived from the original on 2022-06-03. Retrieved 2022-05-29.
3. ↑ 3.0 3.1 3.2 3.3 Ruzicka, Thomas; Ring, Johannes; Przybilla, Bernhard (9 March 2013). Handbook of Atopic Eczema. Springer Science & Business Media. p. 58\. ISBN 978-3-662-02671-7. Archived from the original on 28 June 2022. Retrieved 21 June 2022.
4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Reed, JL; Scott, DE; Bray, M (March 2012). "Eczema vaccinatum". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 54 (6): 832–40. doi:10.1093/cid/cir952. PMID 22291103.
5. ↑ "Smallpox Vaccine Adverse Events: For Healthcare Providers | CDC". www.cdc.gov. 25 March 2021. Archived from the original on 28 June 2022. Retrieved 21 June 2022.
6. ↑ Cherry, James; Demmler-Harrison, Gail J.; Kaplan, Sheldon L.; Steinbach, William J.; Hotez, Peter (29 December 2017). Feigin and Cherry's Textbook of Pediatric Infectious Diseases. Elsevier Health Sciences. p. PT5359. ISBN 978-0-323-39281-5. Archived from the original on 28 June 2022. Retrieved 21 June 2022.
7. ↑ "CDC guidance". Archived from the original on 2015-05-03. Retrieved 2021-12-12.
8. ↑ WHO

## External links[edit | edit source]

Classification|

* ICD-10: B03, T88.1, Y59.1
* ICD-9-CM: 050, 692.9, E949.0

|

* v
* t
* e

Skin infections, symptoms and signs related to viruses

| DNA virus|

| Herpesviridae|

| Alpha.|

| HSV|

* Herpes simplex
* Herpetic whitlow
* Herpes gladiatorum
* Herpes simplex keratitis
* Herpetic sycosis
* Neonatal herpes simplex
* Herpes genitalis
* Herpes labialis
* Eczema herpeticum
* Herpetiform esophagitis

|

B virus|

* B virus infection

VZV|

* Chickenpox
* Herpes zoster
* Herpes zoster oticus
* Ophthalmic zoster
* Disseminated herpes zoster
* Zoster-associated pain
* Modified varicella-like syndrome

Beta.|

* Human herpesvirus 6/Roseolovirus
* Exanthema subitum
* Roseola vaccinia
* Cytomegalic inclusion disease

Gamma.|

* KSHV
* Kaposi's sarcoma

Poxviridae|

| Ortho.|

* Variola
* Smallpox
* Alastrim
* MoxV
* Monkeypox
* CPXV
* Cowpox
* VV
* Vaccinia
* Generalized vaccinia
* Eczema vaccinatum
* Progressive vaccinia
* Buffalopox

|

Para.|

* Farmyard pox: Milker's nodule
* Bovine papular stomatitis
* Pseudocowpox
* Orf
* Sealpox

Other|

* Yatapoxvirus: Tanapox
* Yaba monkey tumor virus
* MCV
* Molluscum contagiosum

Papillomaviridae|

| HPV|

* Wart/plantar wart
* Heck's disease
* Genital wart
* giant
* Laryngeal papillomatosis
* Butcher's wart
* Bowenoid papulosis
* Epidermodysplasia verruciformis
* Verruca plana
* Pigmented wart
* Verrucae palmares et plantares

|

* BPV
* Equine sarcoid

Parvoviridae|

* Parvovirus B19
* Erythema infectiosum
* Reticulocytopenia
* Papular purpuric gloves and socks syndrome

Polyomaviridae|

* Merkel cell polyomavirus
* Merkel cell carcinoma

RNA virus|

| Paramyxoviridae|

* MeV
* Measles

|

Togaviridae|

* Rubella virus
* Rubella
* Congenital rubella syndrome ("German measles")
* Alphavirus infection
* Chikungunya fever

Picornaviridae|

* CAV
* Hand, foot, and mouth disease
* Herpangina
* FMDV
* Foot-and-mouth disease
* Boston exanthem disease

Ungrouped|

* Asymmetric periflexural exanthem of childhood
* Post-vaccination follicular eruption
* Lipschütz ulcer
* Eruptive pseudoangiomatosis
* Viral-associated trichodysplasia
* Gianotti–Crosti syndrome

* v
* t
* e

Adverse drug reactions

Antibiotics|

* Penicillin drug reaction
* Sulfonamide hypersensitivity syndrome
* Urticarial erythema multiforme
* Adverse effects of fluoroquinolones
* Red man syndrome
* Jarisch–Herxheimer reaction

Hormones|

* Steroid acne
* Steroid folliculitis

Chemotherapy|

* Chemotherapy-induced acral erythema
* Chemotherapy-induced hyperpigmentation
* Scleroderma-like reaction to taxanes
* Hydroxyurea dermopathy
* Exudative hyponychial dermatitis

Anticoagulants|

* Anticoagulant-induced skin necrosis
* Warfarin necrosis
* Vitamin K reaction
* Texier's disease

Immunologics|

* Adverse reaction to biologic agents
* Leukotriene receptor antagonist-associated Churg–Strauss syndrome
* Methotrexate-induced papular eruption
* Adverse reaction to cytokines

Other drugs|

* Anticonvulsant hypersensitivity syndrome
* Allopurinol hypersensitivity syndrome
* Vaccine adverse event
* Eczema vaccinatum
* Bromoderma
* Halogenoderma
* Iododerma

General|

| Skin and body membranes|

* Acute generalized exanthematous pustulosis
* Bullous drug reaction
* Drug-induced acne
* Drug-induced angioedema
* Drug-related gingival hyperplasia
* Drug-induced lichenoid reaction
* Drug-induced lupus erythematosus
* Drug-induced nail changes
* Drug-induced pigmentation
* Drug-induced urticaria
* Stevens–Johnson syndrome
* Injection site reaction
* Linear IgA bullous dermatosis
* Toxic epidermal necrolysis
* HIV disease-related drug reaction
* Photosensitive drug reaction

|

Other|

* Drug-induced pseudolymphoma
* Fixed drug reaction
* Serum sickness-like reaction

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