Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination. 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 have a fatal outcome if it is severe enough and not treated.
Thus, the smallpox vaccine should not be given to patients with a past history of eczema, but, due to the danger of transmission of vaccinia, it should not also be given to close contacts who have active eczema and have not been vaccinated. Persons with other skin diseases such as atopic dermatitis, burns, impetigo, or herpes zoster) have also a higher risk of contracting eczema vaccinatum and should not be vaccinated for smallpox.
Differential diagnosis is solved by a culture of vesicular fluid, which will grow vaccinia virus. A skin biopsy wil show necrotic epidermal cells with intranuclear inclusions.
Eczema vaccinatum is a serious medical condition which requires immediate and intensive medical care. Therapy is usually supportive , such as antibiotics, fluid replacement, antipyretics and analgesics, skin healing, etc.; Vaccine Immune Globulin (VIG) can be very useful. Depending on the extension of skin lesions, scarring (pockmarks) may result.
External links