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B D Sathyanarayana
Department of Skin and STD, Government Medical College Mysore-1
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Sathyanarayana B D. Varicella bullosa. Indian J Dermatol Venereol Leprol 2003;69:56-57
AbstractA 3-year-old child diagnosed as varicella bullosa is being presented
Varicella otherwise called chickenpox is the commonest viral infection among children. It is caused by varicella zoster virus which is also known as human herpes virus-3. It is the primary infection with a viraemic stage, after which the virus persists in nerve ganglion cells, usually sensory. Herpes zorter is the result of reactivation of this residual latent virus. This infection confers lasting immunity and secondary attacks are uncommon in healthy individual.
A male child aged about 3 years presented with multiple bullous lesions all over the body and also some ruptured bullae with raw surface.
Initially, one week back without any symptoms, patient developed erythematous rashes which progressed to form small vesicles of sizes of 1 to 2 mm in diameter and prolonged to form bullae.
Examination revealed 10 big bullae measuring about 5cm to 8cm in size, distributed mostly on body and face, of which biggest bulla was over the dorsum of the left hand. Most of the bullae were flaccid and onefourth of the bullous cavity was filled with thin pus. Many small bullae of size 1x2cm were also present here and there.
In addition, pleomorphic chickenpox lesions were present all over the body, mostly on centripetal region. Tzanck smear of early blister shows many acantholytic baloon cells; child had high degree of fever. Diagnosis of varicella bullosa was made.
Apart from typical chickenpox, varicella haemorragica, varicella gangrenosa, varicella neonatorum, congenital varicella and varicella bullosa are some of the types of chickenpox., Varicella bullosa is very rare and not reported in IJDVL Journal.
Among many complications of varicella, sepsis is most common. Impetigo, absesses, regional lymphadinitis, cellulitis, erysipelas, scarlet fever, bacteremia, pnemonia, osteomyelitis and septic arthritis are some of the manifestations of secondary bacterial infections. Commonest organisms includes streptococcus pyogens and staphylococci aureus.
We have to differentiate varicella bullosa with bullous impetigo which is usually 1 to 2cms in size and sites of predilection are perineum, periumbilical region and neck creases; after ruptur of bullae, thin flat brownish crust are formed with central healing and peripheral extensions may give rise to cercinate lesion, commonly few lesions will be present.
In varicella bullosa, chickenpox lesions developing in to large bullae due to super infection with toxin producing staphylococcal aureus which causes epidermolysis., Prognosis is excellent and responds well with antistaphylococcal antibiotics.
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