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


Previously, autoinoculation was a common sequela of vaccination occurring both in vaccinees and close family contacts. It accounted for 50% of all the adverse events following primary and revaccination. The most common sites were the face, eyelids, nose, mouth, genitalia, and rectum (Figure 5). Although most lesions healed without specific therapy, occasionally vaccinia immune globulin (VIG) was required for more severe cases.

Post-vaccination autoinoculation can occur in vaccinees and close contacts. It commonly affects the eyelids, face, and genital region. Reprinted with permission from Smallpox and Its Eradication.[6]

Patient education, careful hand washing, antipruritics, and physical barriers are recommended to avoid this complication. Current recommendations suggest using semipermeable polyurethane dressings like Opsite (Smith and Nephew, London, UK) which effectively block shedding of vaccinia and recombinant vaccinia viruses.[45] The vaccination site is covered with dry gauze to prevent accumulation of exudate and the semipermeable dressing applied over this. The dressing is changed once a day and scrupulous hygiene is observed.


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