Eczema vaccinatum 1477063 225964772 2008-07-16T06:16:28Z Optigan13 3457187 Swapped image, original(CDC-PHIL #5217) about to be deleted as copyrighted [[Image:Eczema vaccinatum infant.jpg|thumb|right|This 8 mo. old boy developed eczema vaccinatum after he had acquired vaccina from a sibling recently vaccination for smallpox. Source: CDC/Arthur E. Kaye]] '''Eczema vaccinatum''' is a rare severe [[adverse effect (medicine)|adverse reaction]] to [[smallpox]] [[vaccination]]. It is characterized by serious local or disseminated, umbilicated, vesicular, crusting [[skin rash]]es 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 not treated. 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, [[burn (injury)|burns]], [[impetigo]], or [[herpes zoster]]) also have an increased risk of contracting eczema vaccinatum and should not be vaccinated against smallpox. '''[[Differential diagnosis]]''': A culture of vesicular fluid will grow [[vaccinia]] [[virus]]. Skin [[biopsy]] shows [[necrosis|necrotic]] [[Epidermis (skin)|epidermal]] cells with intranuclear inclusions. Eczema vaccinatum is a serious medical condition which requires immediate and [[intensive care|intensive]] medical care. Therapy has been [[supportive care|supportive]], such as [[antibiotic]]s, [[fluid replacement]], [[antipyretics]] and [[analgesics]], skin healing, etc.; [[Vaccinia Immune Globulin]] (VIG) could be very useful but supplies may be defficient in 2006. Antiviral drugs have been examined for activity in pox viruses and Cidofovir is believed to be active [http://www.cdc.gov/ncidod/monkeypox/treatmentguidelines.htm CDC guidance] [http://www.who.int/csr/disease/smallpox/cidofovirtreatment/en/ WHO]. Eczema also mixes poorly with other vesiculating viruses such as Chickenpox - see [[eczema herpeticum]]. ==Recent Cases== In March 2007, a two-year-old Indiana boy and his mother contracted the life-threatening [[vaccinia]] infection from his soldier father's smallpox vaccination. The boy developed the telltale rash over 80 percent of his body after coming into close contact with his father, who was vaccinated for smallpox before being deployed overseas by the Army (the military resumed smallpox vaccinations in 2002). The child acquired the infection due to eczema, which is a known risk factor for vaccinia infection. He continues to be in a critical condition, but is slowly improving.<ref>{{cite news |url=http://www.nytimes.com/2007/05/18/health/18smallpox.html?_r=1&ref=health&oref=slogin |title=Soldier’s Smallpox Inoculation Sickens Son|last=Schwartz|first=John |publisher=New York Times |date=2007-05-18 |accessdate=2007-05-18}}</ref> ==External links== * [http://www.bt.cdc.gov/agent/smallpox/vaccination/reactions-vacc-public.asp Side Effects of Smallpox Vaccination]. Centers for Disease Control and Prevention Fact Sheet. * [http://www.bt.cdc.gov/Agent/Smallpox/VaccineImages.asp Vaccine Reaction Images]. CDC. * [http://dermatology.about.com/library/bldefeczvacc.htm Eczema vaccinatum]. About. ==References== <div class="references-small"> <references /> </div> {{infectious-disease-stub}} [[Category:Vaccination]] [[Category:Dermatology]]