Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Acta Paediatr. 2022 May;111(5):935-939. doi: 10.1111/apa.16300. Epub 2022 Feb 27.
In previously healthy subjects, primary varicella presents with a distinctive vesicular rash that is more intense on the trunk and head than on the extremities. However, an atypical presentation may occasionally develop. We aimed at systematically assessing the characteristics of cases affected by atypical primary varicella rash.
The United States National Library of Medicine, Excerpta Medica and Web of Science databases were reviewed, without date or language restrictions. Articles were eligible if reporting previously healthy and immunocompetent subjects with a primary varicella rash (i.e., a photo-localised primary varicella or skin inflammation-associated primary varicella).
Thirty-eight reports providing information on 59 cases of atypical primary varicella were identified. Twenty-four cases (median 8.5 years of age, 19 females) were photo-localised and 35 (median 4.8 years of age, 15 females) were associated with pre-existing skin inflammation (including cast occlusion, diaper irritation, operative sites, burns, insect bites, vaccinations or pre-existing skin disease). The skin rash was monomorphic and without a "starry sky" appearance.
Primary varicella may have a modified presentation in areas of irritation such as sun exposure or pre-existing inflammation. There is a need for a wider awareness of these modulators of varicella rash.
在既往健康的个体中，初次感染水痘表现为特征性的水疱性皮疹，其在躯干和头部的严重程度比四肢更严重。然而，偶尔可能会出现不典型表现。我们旨在系统评估受不典型初次水痘皮疹影响的病例的特征。
我们对美国国家医学图书馆、荷兰医学文摘和科学网数据库进行了检索，未设时间和语言限制。如果文章报告了既往健康且免疫功能正常的个体出现初次水痘皮疹（即局部性初次水痘或与皮肤炎症相关的初次水痘），则将其纳入。
共确定了 38 份报告，这些报告提供了 59 例不典型初次水痘的信息。24 例（中位数年龄为 8.5 岁，女性 19 例）为局部性，35 例（中位数年龄为 4.8 岁，女性 15 例）与先前存在的皮肤炎症有关（包括贴布贴扎处、尿布疹、手术部位、烧伤、昆虫叮咬、疫苗接种或先前存在的皮肤疾病）。皮疹形态单一，没有“星空”外观。
初次水痘在受到刺激的区域（如阳光照射或先前存在的炎症）可能表现为不典型。需要提高对这些水痘皮疹调节剂的认识。
