Overview
An acute infectious disease of the adult skin caused by varicella zoster virus infection.
Rash may appear in batches, including macules, papules, blisters, etc., and different stages of lesions may be seen all over the body.
Mainly includes general treatment, drug treatment, early application of antiviral drugs can shorten the course of the disease.
Adult chickenpox is generally more serious, and death may occur in severe cases.
Definition
Adult varicella is an acute infectious disease caused by varicella-zoster virus infection in adults through respiratory droplets and direct contact.
Adults infected with varicella zoster virus are usually sicker than children with chickenpox. Chickenpox can occur throughout the year, mostly in winter and spring, and can result in long-lasting immunity.
The prognosis of chickenpox in adults is generally good, but more severe symptoms require active treatment to avoid complications such as secondary bacterial infections and encephalitis [1-2,5-8].
Morbidity
Chickenpox is predominantly in children, with a low incidence in adults and <2% of cases occurring after the age of 20 years [3].
Causes
Causes
Source of infection
Chickenpox patients are the only source of infection, usually 1-2 days before the onset of the disease until the rash is completely crusted.
Route of transmission
Varicella zoster virus can be transmitted through respiratory droplets and direct contact, but also indirectly through contaminated utensils [1-5].
Susceptible Population
Varicella-zoster virus is highly contagious, and the population is generally susceptible to chickenpox. Adults with low resistance who are not protected by antibodies can be infected and develop disease after contact with the infectious agent of chickenpox patients.
Immunocompromised adults with malignant tumors and adults on long-term immunosuppressive drugs are at high risk for varicella-zoster virus infection.
Pathogenesis
The virus invades the human body through the upper respiratory tract, oral cavity, and conjunctiva, and then transports to the skin tissues, internal organs, and the nervous system, forming viremia and causing skin and systemic tissue and organ lesions. Specific antibodies appear 2 to 5 days after the onset of disease, viremia disappears, and the symptoms improve.
Dermatologic changes caused by varicella in adults are mainly manifested in the epidermal spinal cell layer, and tissue fluid infiltration may be present at the lesions to form varicella herpes [1-2,4-5].
Symptoms
Main symptoms
Varicella in adults can be characterized by the following main symptoms.
Rash
After infection with the virus, a rash may appear on the trunk, head, face, limbs and other parts of the body. The lesions are initially maculopapular, then rapidly become papular, followed by characteristic blisters with an umbilicus in the center of the blisters; these lesions then develop into pustules, which then form crusts.
Lesions at different stages of development are usually seen on the whole body, i.e., the “four-in-a-row” phenomenon.
Adult varicella has an atypical centripetal distribution of lesions with atypical presentations. Immunocompromised adults may develop disseminated varicella, with lesions fusing into blisters, necrosis, blood blisters, and even hemoptysis and cyanosis [1-3].
Systemic symptoms
Chilliness: the patient’s body is afraid of cold and sensitive to cold.
Fever: patients may have low to moderate fever after being infected with varicella-zoster virus, with body temperature ranging from 37.3℃ to 38℃. It may be accompanied by headache, fatigue and other symptoms.
Sore throat: Varicella-zoster virus can attack the throat area, resulting in tissue damage and causing sore throat.
Gastrointestinal discomfort: Patients infected with varicella-zoster virus may experience varying degrees of gastrointestinal discomfort, including nausea and loss of appetite.
Coughing: People with combined pneumonia may cough up sputum and even blood.
Complications
Pneumonia: Adults infected with varicella virus may develop pneumonia, which may include high fever, coughing up sputum, hemoptysis, chest pain and even respiratory distress.
Encephalitis: The virus can invade the brain tissue and cause viral encephalitis and Reye’s syndrome, with symptoms such as fever, headache, nausea and vomiting, seizures and even mental abnormalities and impaired consciousness.
Impact on fetus: If chickenpox occurs in adults in early pregnancy (8~20 weeks), varicella herpes virus can affect the growth and development of the fetus, inducing skin scars, limb deformities, neurodevelopmental disorders affecting the intelligence of the fetus and so on.
Secondary infection: Herpes ulceration can be followed by secondary infection of varying degrees, and infectious complications include cellulitis, myositis, necrotizing fasciitis and toxic shock syndrome [1-3].
Medical treatment
Department of Medicine
Dermatology
When skin lesions such as red patches, papules and herpes appear on the body, it is recommended to consult a doctor promptly.
Department of Infectious Diseases
Adults with skin lesions accompanied by systemic symptoms such as chills and fever may also consult the Department of Infectious Diseases.
Preparation for medical treatment
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for medical care
Chickenpox in adults may progress in the sequence of rash-papule-blister-scab, and photographs may be taken before the consultation for reference.
It is not recommended to cover up the blemishes before the consultation to avoid affecting the doctor’s judgment or causing different degrees of infections on the affected area.
Preparation List
Symptom list
Pay special attention to the time of onset of symptoms, special manifestations, etc.
When did the rash appear? Are there any blisters?
Is there any itching at the site of the rash?
Was the rash preceded or accompanied by fever, chills, sore throat, or malaise? Is there any correlation between the fever and the time of rash onset?
Is the rash accompanied by discomfort in any system other than the skin?
Are there any blisters or ulcers on the oral mucosa and throat?
List of medical history
Is there chronic use of immunosuppressive drugs?
Is there any immunocompromising disease such as malignancy?
Was there contact with a varicella patient prior to onset of illness?
Diagnosis
Basis of diagnosis
Medical history
Has had close or indirect contact with patients with varicella or herpes zoster.
Possible long-term use of immunosuppressive drugs or a disease that causes immunocompromise such as malignancy [1-3,6-11].
Clinical manifestations
Symptoms.
The patient develops a red maculopapular rash on the trunk, head, face, and limbs, which may change to papules and develop into herpes after a few hours. It may be accompanied by itching.
There may be chills, fever, headache, fatigue, sore throat, nausea, loss of appetite and other generalized discomfort.
In adult patients, the rash is usually more severe, and symptoms of pneumonia such as high fever, coughing up sputum, hemoptysis, chest pain and even dyspnea may occur.
Laboratory Tests
Blood Tests
Purpose: To detect fluctuations in the total number of white blood cells and the number of lymphocytes in the patient’s body.
Significance: The total number of white blood cells in adult chickenpox patient’s body is normal or increased, and the lymphocyte fraction may be elevated.
Herpes Scrape
Purpose: To detect the presence of herpes virus inclusions.
Significance: To assist in the diagnosis of herpes by scraping the basal layer of herpes tissue and using a specific stain to look for herpes virus-specific intranuclear inclusion bodies. Not performed in most hospitals.
Other tests
Serologic examination: Enzyme-linked immunosorbent assay or complement binding assay to detect varicella herpes virus-specific antibodies to help differential diagnosis. However, most hospitals do not carry out at present.
Pathogenetic examination: virus isolation, antigen detection, nucleic acid detection to realize rapid early diagnosis [1-3]. However, most hospitals do not carry out at present.
Differential diagnosis
Herpetic pemphigoid
Similarity: Herpes-like changes.
Differences: Herpetic pemphigoid has a chronic onset and is most common in the elderly. Typical lesions are urticarial plaques and tense blisters on the trunk and extremities. Intense pruritus is more common. A well-done biopsy and pemphigus-related antibodies may assist in the diagnosis.
Severe drug rash
Similarities: Both may present with a blistering rash.
Differences: After a brief prodromal period of fever and flu-like symptoms, patients with severe drug rash present with painful erythematous and purpuric plaques or diffuse areas of maculopapular erythema, progressing to blisters, macules, and necrotic shedding of the skin, which is closely associated with drug exposure.
Prickly heat
Similarities: Both may present with a blistering rash.
Difference: prickly heat is caused by blockage of the ducts of small sweat glands and often occurs in overheated environments. It is characterized by 1 mm blisters within or under the stratum corneum that are easily ruptured.
Treatment
Treatment principle: timely isolation, early comprehensive symptomatic treatment, reduce complications.
Treatment objective: symptomatic treatment, early application of antiviral drugs can shorten the course of the disease and prevent serious complications.
General treatment
Attention to rest: patients with fever should rest in bed, give easy-to-digest food and pay attention to replenish water.
Attention to daily skin care: chickenpox patients need to strengthen the care, keep the skin clean [1-5]. Chickenpox patients should not scratch the herpes, which may induce secondary infection and aggravate the condition.
Medication
Antiviral treatment
If necessary, antiviral drugs can be used to treat, commonly used drugs are mainly acyclovir, famciclovir, vasiclovir, etc. It is recommended that they should be used as early as possible, and treatment within 24 hours of the appearance of the rash can play a better therapeutic effect. Severe chickenpox can be treated with brivudine.
Symptomatic treatment
Topical antipruritic drugs
Commonly used drugs: glycerine lotion, povidone-iodine, antihistamines (doxepin cream, benadryl cream, etc.).
Pharmacological effects: astringent, protective effect of the skin, to play a certain anti-itching effect.
Precautions: prohibited for those who are allergic to the drug, prohibited for those with skin allergies, avoid contact with eyes during use [1-3,6-11].
Other drugs
Patients with fever can use non-steroidal anti-inflammatory drugs to reduce fever and so on. Antibiotic cream can be used for secondary infection.
Prognosis
Cure
Mild cases of adult chickenpox are fairly self-healing and usually resolve in remission.
Severe adult chickenpox is generally more difficult to self-cure, the course of the disease can be several weeks, early treatment to reduce the severity of chickenpox and shorten the duration of the disease. Pneumonia, encephalitis, and secondary serious infections occur, and the prognosis is poor. Immunocompromised people are prone to form disseminated chickenpox, and the mortality rate is extremely high if the disease is severe and multiple organs are invaded by the virus [1-3].
Prognostic factors
Early treatment: the earlier the antiviral treatment, the sooner the rash can be controlled and the recovery accelerated.
Immunity status: patients with lower immunity have a higher probability of developing severe varicella and a higher risk of pneumonia, encephalitis, and death.
Harmfulness.
Adults with chickenpox are generally in a more serious condition, and those with severe disease and complication of encephalitis have a poor prognosis, which may even trigger the patient’s death.
Daily
Daily management
Dietary management
For patients with fever, bed rest should be paid attention to, during the rest period, food should be easy to digest (such as eggs, milk, fruits and vegetables, etc.) and pay attention to replenish water.
Patients should avoid drinking alcohol in daily life and avoid eating too stimulating food to avoid affecting the skin recovery.
Lifestyle management
Improve poor lifestyle, patients should pay attention to rest, avoid staying up late, avoid strenuous exercise.
Enhance the moisturizing and cleaning of the affected skin. At the same time, all kinds of pollutants should be avoided to induce different degrees of infection. Avoid scratching the skin papules or herpes to induce skin ulceration and infection.
Prevention
Attention to good protection: the main source of adult chickenpox is chickenpox patients, susceptible people need to wear masks and avoid direct contact with patients to avoid infection.
Pay attention to environmental hygiene: patients’ rooms should be ventilated in the morning and evening, disinfected with ultraviolet light once a day, the floor should be wiped with 84 disinfectant, and the air, clothes and utensils contaminated by the patients’ respiratory tracts and secretions in the rashes should be soaked with 84 disinfectant for 30 minutes before being sent to the wash, and then be thoroughly disinfected.
Vaccination: High-risk groups can receive chickenpox vaccine and herpes zoster vaccine to establish an immune barrier to prevent chickenpox-herpes zoster infection.
Pay attention to lifestyle adjustment: avoid staying up late, quit smoking and alcohol adverse stimuli, pay attention to reasonable exercise to improve body immunity [1-3,12-13].