Varicella (Chickenpox)

Skin Lesion: Rapidly evolving pruritic rash. Classically described as "dew drops on a rose petal" (clear vesicles on an erythematous base). Lesions appear in "crops" and exhibit pleomorphism (macules, papules, vesicles, and crusts present simultaneously).

Distribution:

Centripetal distribution: Starts on the trunk and scalp, then spreads peripherally to the face and limbs. Mucosal involvement (mouth/genitals) is common.

Measles (Rubeola)

• The Clue: The 3 C's (Cough, Coryza, Conjunctivitis) + Koplik spots (white spots on buccal mucosa). Rash is maculopapular and confluent.
• Vs Varicella: Measles rash starts at the hairline/face and moves downward (craniocaudal); Varicella starts on the trunk. Measles lesions are not vesicular.

Hand, Foot, and Mouth Disease (HFMD)

• The Clue: Small, elliptical/grayish vesicles on an erythematous base, specifically located on the palms, soles, and oral mucosa.
• Vs Varicella: HFMD is highly localized to the hands, feet, and mouth; Varicella is generalized across the trunk and scalp.

🚨 Refer/Monitor Closely if:

• Pregnancy: High risk of maternal pneumonia and fetal complications.
• Immunocompromised status.
• Systemic Complications: Shortness of breath (Pneumonia) or neurological signs (Encephalitis).
• Secondary Bacterial Infection: Cellulitis or Necrotizing Fasciitis.

Antiviral (Optimal <72H)
Indicated for severe case, immunocompromised patients, pregnant women, adults (especially over 12)

• Acyclovir: 800mg 5x daily for 7 days.
  [Child: 20mg/kg QID for 5 days]
• Valacyclovir: 1g TDS for 7 days.
  [Child: 20mg/kg TDS for 5 days]
• Famciclovir: 500mg TDS for 7 days.

Symptomatic Treatment

• Cetirizine 10mg OD.
  [Child: 0.25mg/kg OD]
• Piriton 4mg ON/TDS.
  [Child: 0.1mg/kg ON/TDS]
• Paracetamol 1g TDS.
  [Child: 0.15mg/kg QID]
• Calamine Lotion

⚠️ Safety Pearl: Avoid NSAIDs (e.g., Ibuprofen) due to the risk of severe secondary skin infections.

📸 Images