Smallpox: What the Dermatologist Should Know

Phyllis I. Spuls, MD; Jan D. Bos, MD, PhD; Donald Rudikoff, MD


Skinmed. 2004;3(4) 

In This Article

Vaccinia Necrosum

Vaccinia necrosum (gangrenosum) or progressive vaccinia was a severe and sometimes fatal complication that occurred in persons with underlying immune deficiency following primary vaccination or revaccination. The inoculation site lesion failed to heal and progressive necrosis of this site and surrounding areas developed (Figure 7). Secondary lesions, described as metastatic, appeared at distant anatomical locations and also exhibited progressive necrosis.[51] VIG was used to treat this complication with varying success. When a person's history suggests an unusual susceptibility to infection, screening for occult immunosuppression should be performed to prevent this complication.

Progressive vaccinia occurred in vaccinees with abnormal immune systems. The primary vaccination reaction expanded slowly but relentlessly causing progressive necrosis. It was usually fatal. Reprinted with permission from Smallpox and Its Eradication.[6]


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