Eczema vaccinatum

Eczema vaccinatum, a potentially serious complication, occurs in people who have eczema, atopic dermatitis, or a history of eczema or atopic dermatitis. It can also occur in vaccine recipient contacts with these conditions. Eczema vaccinatum is 

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Generalized vaccinia Secondary lesions of the skin following vaccination which may occur in subjects with previously healthy skin but are more common in the case of traumatized skin, especially in the case of eczema(eczema vaccinatum). In the latter instance, generalized vaccinia may result from mere contact with a vaccinated person. Secondary vaccinial lesions may also occur following transfer of virus from the vaccination to another site by means of the fingers (autoinnoculation). 

Vaccinia Vaccinia immune globulin Consult the CDC.3 Treatment of severe reactions to vaccinia vaccination, including eczema vaccinatum, vaccinia necrosum, and ocular vaccinia. Available from the CDC.3... 

Acute febrile neutrophilic dermatosis (49) and eczema vaccinatum (50) have been reported after BCG immunization. 

Sadeghi E, Kumar PV. Eczema vaccinatum and postvaccinal BCG adenitis—case report. Tubercle 1990 71(2) 145-6. 

During the US pre-event smallpox vaccination program, there were no reports of eczema vaccinatum, progressive Vaccinia, or fetal Vaccinia (19,20). 

Eczema vaccinatum. This serious complication occurs most often in infants with active infantile eczema and occasionally in adults who have eczema or some other skin disease. It is seen after vaccination or contact with vaccinated persons with vaccinial lesions. The first symptoms are observed at the eczematous spots 3 days after vaccination. In many cases generalization of the vaccinial lesions follows. The estimated mortality is 25-30%. 

Fig. 2.10 (See color plate) Severe eczema vaccinatum in a 22 year old. From Smallpox vaccination adverse reaction. CDC Smallpox. http //www.bt.cdc.gov/training/smaUpoxvaccine/reactions/ adverse.html...

People with a history or current outbreak of eczema or atopic dermatitis People with Darier disease (keratosis follicularis) are also at risk for eczema vaccinatum and should not receive the vaccine. 

Vaccinia immune globulin IV is a vaccinia-specific immunoglobulin G (IgG), which directly neutralizes vaccinia virus. It is indicated in treatment and/or modification of aberrant infections induced by vaccinia virus (including accidental implantation in eyes, mouth, or other areas where vaccinia infection would constitute a special hazard), eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, and vaccinia infections in individuals who have skin conditions such as bums, impetigo, varicella-zoster, or poison ivy, or in individuals with eczematous skin lesions. Treat complications that include vaccinia keratitis with caution. 

It possesses prophylactic value against smallpox and alastrim. In conjunction with gamma globulin it shows its usefulness against eczema vaccinatum and vaccinia gangrenosa. 

More severe complications of vaccinia vaccination include eczema vaccinatum, progressive vaccinia, and postvaccinial encephalitis. These complications are rare, but occur at least 10 times more often among primary vaccinees than among revaccinees. Eczema vaccinatum is a localized or systemic dissemination of vaccinia virus among persons who have eczema (Figure 27-7). Although usually mild and self-limited, this complication could be severe or even fatal in up to 10% of cases. 

Vaccinia-immune globulin (VIG) is of value in the treatment of progressive vaccinia, eczema vaccinatum,97 and perhaps ocular vaccinia (VIG is discussed below in the section titled Passive Immunoprophylaxis). Topical idoxuridine may benefit vaccinia keratitis.98 99... 

Fig. 27-7. Eczema vaccinatum. The widespread pox lesions on this patient s eczematous skin illustrate the severe illness that can occur in up to 10% of cases. Reprinted with permission from Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID. Smallpox and Its Eradication. Geneva, Switzerland World Health Organization 1988 298. Photograph by I. D. Ladyni.

Eczema vaccinatum. Serious skin rashes caused by widespread infection of the skin in people with skin conditions such as eczema or atopic dermatitis. 

Thiosemicarbazones - l-Methylisatin-3-thiosemicarbazone (methisazone "Marboran") prevented but did not cure smallpox in man and had a favorable effect on eczema vaccinatum and vaccinia gangrenosa A wider range of activity was seen in tissue culture with adeno, polio, varicella... 

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