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

Other Local Reactions

Localized reactions may occur from the live vaccinia virus or from allergy to the component parts of the vaccine such as inert proteins or preservatives. The latter may manifest as localized erythematous or urticarial delayed hypersensitivity reactions. Bacterial and sterile cellulitis may occur. Occasionally, a severe localized vaccinia reaction occurs with pruritus, extensive erythema, edema, induration, lymphadenitis, and multiple blisters. Management is usually conservative using antipruritics and nonsteroidal anti-inflamma-tory drugs and resting the affected limb.

The most serious form of autoinoculation, ocular vaccinia, may result in keratitis and/or corneal ulceration. VIG is indicated for vaccinia of the eye but should not be used for keratitis or ulceration due to an increased risk of corneal scarring.[46]In the cases of ocular vaccinia reported in 2003, trifluridine eye drops were used in both patients and VIG was used in one.[40]


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