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Picture of the Month

Evan G. Pattishall III, MD; Murray Feingold, MD
Am J Dis Child. 1985;139(8):795-796. doi:10.1001/archpedi.1985.02140100057029.
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Denouement and Discussion 


Manifestations  Varicella is usually a mild viral illness characterized by a vesicular pruritic rash that appears in crops. The rash begins as a macule that then develops into a vesicle on an erythematous base described as a "dewdrop on a rose petal." The vesicles, which appear on the skin or mucous membranes, crust and usually heal with little, if any, scarring. Rarely, children with varicella may develop complications such as a secondary bacterial infection, hemorrhagic varicella, bullous lesions, pneumonia, hepatitis, encephalitis, Reye's syndrome, myocarditis, and arthritis. Previous reports have suggested that individuals who develop varicella while receiving steroid therapy are at risk for developing a more fulminant course marked by prolonged duration of the disease, higher temperatures, more extensive rash, and possibly disseminated infection and death. Steroid therapy has also been reported to reactivate varicella in patients who have recently recovered from the illness. However, recent


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