Varicella Initial Assessment

Varicella  

Varicella usually occurs 10-21 days after exposure. A prodrome of fever (<38.9°C), headache, malaise, pharyngitis and abdominal pain may occur 1-2 days before the development of a rash in older children and adults. In younger children, rash and fever typically occur simultaneously without prodromal symptoms. Duration of symptoms is usually 4-7 days. Breakthrough cases occurring >42 days after vaccination generally present with milder symptoms (<50 skin lesions appearing as atypical maculopapular rashes with few or no vesicles).

The hallmark sign of varicella is a pruritic rash that begins on the scalp and face, which eventually spreads to the trunk and extremities. Such pruritic rash progresses into macules, papules and vesicles. Lesions in varying stages of development are a characteristic sign of varicella. The lesions appear as small fluid-filled vesicles with an erythematous base having a “dewdrop-on-a-rose-petal” appearance. Within 24-48 hours, the vesicles transform into pustules that crust and scab within 6 days. New lesions may arise in successive crops over 3-4 days. Other signs include ulcerative and often painful lesions that appear on mucous membranes, including the oropharynx, conjunctivae and vagina. 

Herpes Zoster  

The prodromal symptoms of herpes zoster include fever, headache, malaise, pruritus, hyperesthesia or paresthesia described as burning, deep aching, tingling, itching or stabbing pain that ranges from mild to severe, in the affected dermatome which may occur days to weeks before the development of rash.   

The prodromal phase is followed by a pruritic, vesicular rash that usually appears unilaterally along the thoracic, cervical and ophthalmic dermatomes without crossing the midline. The rash initially appears as a maculopapular rash that follows a dermatomal distribution, commonly referred to as a “belt-like pattern,” then evolves into vesicles with an erythematous base. It usually affects the thoracic dermatomes (55%), then trigeminal (20%), cervical (11%), lumbar (13%), and sacral (2%) dermatomes. Other patients may experience involvement of adjacent dermatomes.







Vesicles are often painful and their development can be accompanied by anxiety and flu-like symptoms. The vesicles often coalesce into larger, fluid-filled or pustular lesions, become hemorrhagic or ulcerated, then crust within 7-10 days and fall off within 2-4 weeks, which may leave scars or pigmentary changes.