Chickenpox Differential Diagnoses

  • Author: Anthony J Papadopoulos, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 20, 2011
 
 

Diagnostic Considerations

Diagnostic considerations in cases of suspected chickenpox include viral exanthems, pityriasis lichenoides et varioliformis acuta, disseminated herpes simplex virus infection, atypical herpes zoster, rickettsial disease, and neonatal syphilis.

All of the differential diagnoses listed are active considerations, with the exception of smallpox, which would be a concern in the event of biologic warfare.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Anthony J Papadopoulos, MD  Private Practice

Anthony J Papadopoulos, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, Medical Society of New Jersey, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Susan M Swetter, MD  Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Choo PW, Donahue JG, Manson JE, Platt R. The epidemiology of varicella and its complications. J Infect Dis. Sep 1995;172(3):706-12. [Medline].

  2. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. Feb 3 2005;352(5):450-8. [Medline].

  3. Aebi C, Ahmed A, Ramilo O. Bacterial complications of primary varicella in children. Clin Infect Dis. Oct 1996;23(4):698-705. [Medline].

  4. Higuchi S, Toichi E, Kore-eda S, et al. An adult case of Fournier's gangrene preceded by varicella. Acta Dermatol Kyoto. 1997;92(4):375-80.

  5. Miller HC, Stephan M. Hemorrhagic varicella: a case report and review of the complications of varicella in children. Am J Emerg Med. Nov 1993;11(6):633-8. [Medline].

  6. Forrest J, Mego S, Burgess M. Congenital and neonatal varicella in Australia. J Paediatr Child Health. Apr 2000;36(2):108-13. [Medline].

  7. Auriti C, Piersigilli F, De Gasperis MR, Seganti G. Congenital Varicella Syndrome: Still a Problem?. Fetal Diagn Ther. May 27 2009;25(2):224-229. [Medline].

  8. Tsunoda T, Ogawa S. A consideration on the distribution of eruption of herpes zoster. Acta Dermatol Kyoto. 1986;81:95-8.

  9. Schwartz RA, Jordan MC, Rubenstein DJ. Bullous chickenpox. J Am Acad Dermatol. Aug 1983;9(2):209-12. [Medline].

  10. Lunghi F, Finzi M. Varicella bullosa in HIV+ adults. Chronica Dermatologica (Roma). 1997;7:557-60.

  11. Hirota T, Hirota Y, Ichimiya M, et al. Atypical varicella seen in a woman with atopic dermatitis. Acta Dermatol Kyoto. 1998;93(1):65-8.

  12. Nahass GT, Goldstein BA, Zhu WY, Serfling U, Penneys NS, Leonardi CL. Comparison of Tzanck smear, viral culture, and DNA diagnostic methods in detection of herpes simplex and varicella-zoster infection. JAMA. Nov 11 1992;268(18):2541-4. [Medline].

  13. Harbecke R, Oxman MN, Arnold BA, et al. A real-time PCR assay to identify and discriminate among wild-type and vaccine strains of varicella-zoster virus and herpes simplex virus in clinical specimens, and comparison with the clinical diagnoses. J Med Virol. Jul 2009;81(7):1310-22. [Medline].

  14. Chartrand SA. Varicella vaccine. Pediatr Clin North Am. Apr 2000;47(2):373-94. [Medline].

  15. Durrheim DN. Varicella vaccine: local convenience or global equity?. Lancet. Dec 23 2006;368(9554):2208-9. [Medline].

  16. Kamiya H, Ito M. Update on varicella vaccine. Curr Opin Pediatr. Feb 1999;11(1):3-8. [Medline].

  17. Vázquez M, Shapiro ED. Varicella vaccine and infection with varicella-zoster virus. N Engl J Med. Feb 3 2005;352(5):439-40. [Medline].

  18. Wutzler P, Knuf M, Liese J. Varicella: efficacy of two-dose vaccination in childhood. Dtsch Arztebl Int. Aug 2008;105(33):567-72. [Medline].

  19. Dunkle LM, Arvin AM, Whitley RJ, et al. A controlled trial of acyclovir for chickenpox in normal children. N Engl J Med. Nov 28 1991;325(22):1539-44. [Medline].

  20. Vinzio S, Lioure B, Goichot B. Varicella in immunocompromised patients. Lancet. Dec 23 2006;368(9554):2208. [Medline].

  21. Safrin S, Berger TG, Gilson I, et al. Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection. Ann Intern Med. Jul 1 1991;115(1):19-21. [Medline].

  22. Asano Y, Nagai T, Miyata T, et al. Long-term protective immunity of recipients of the OKA strain of live varicella vaccine. Pediatrics. Apr 1985;75(4):667-71. [Medline].

  23. [Guideline] Centers for Disease Control and Prevention. A new product (VariZIG) for postexposure prophylaxis of varicella available under an investigational new drug application expanded access protocol. MMWR Morb Mortal Wkly Rep. Mar 3 2006;55(8):209-10. [Medline].

  24. [Guideline] Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices. Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. MMWR Morb Mortal Wkly Rep. Mar 14 2008;57(10):258-60. [Medline].

  25. [Guideline] Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. May 7 2010;59:1-12. [Medline]. [Full Text].

  26. [Guideline] Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2009*. Ann Intern Med. Jan 6 2009;150(1):40-4. [Medline].

  27. [Guideline] Centers for Disease Control and Prevention. Recommended adult immunization schedule--United States, 2011. MMWR Morb Mortal Wkly Rep. Feb 4 2011;60(4):1-4. [Medline]. [Full Text].

  28. [Guideline] American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics. Jul 2007;120(1):221-31. Reaffirmed July 2010. [Medline].

  29. [Guideline] American Academy of Pediatrics Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedules--United States, 2009. Pediatrics. Jan 2009;123(1):189-90. [Medline].

  30. [Guideline] Committee on Infectious Diseases; American Academy of Pediatrics. Policy statement--recommended childhood and adolescent immunization schedules--United States, 2011. Pediatrics. Feb 2011;127(2):387-8. [Medline]. [Full Text].

  31. Snoeck R, Andrei G, De Clercq E. Current pharmacological approaches to the therapy of varicella zoster virus infections: a guide to treatment. Drugs. Feb 1999;57(2):187-206. [Medline].

  32. LaRussa P, Steinberg S, Meurice F, Gershon A. Transmission of vaccine strain varicella-zoster virus from a healthy adult with vaccine-associated rash to susceptible household contacts. J Infect Dis. Oct 1997;176(4):1072-5. [Medline].

  33. McCrary ML, Severson J, Tyring SK. Varicella zoster virus. J Am Acad Dermatol. Jul 1999;41(1):1-14; quiz 15-6. [Medline].

  34. Papadopoulos AJ, Schwartz RA, Janniger CK. Chickenpox. Cutis. Jun 2000;65(6):355-8. [Medline].

 
Previous
Next
 
Dewdrop on rose petal characteristic vesicle of chickenpox. Reprinted with permission from Cutis 65: 355, 2000.
Vesicular eruption on the trunk demonstrating papules, vesicles, and crusts. Reprinted with permission from Cutis 65: 355, 2000.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.