Dermatology

Question 1

Pearls of Varicella Zoster (shingles)

Answer 1

pain precedes rash groups of vesicles in a unilateral dermatomeal pattern

Tzanck prep positive for multinucleated giant cells

Hutchinson’s sign - lesion on the nose. concern for eye involvement (Herpes Zoster Opthalmicus)

Question 2

Diagnosis of Varicella Zoster (shingles)

Answer 2

in ED it was clinical

+ Tzanck prep demonstrates multinucleated giant cells – but less sensitive than PCR or direct immunofluorescence

if testing is deemed necessary a PCR or direct immunofluroescence (DFA) are the tests of choice

(allow differentiation between HSV AND VZV INFECTIONS)

Question 3

Treatment for Varicella Zoster (shingles)

Answer 3

oral acyclovir may be considered for those with an increased risk of severe infection,

acyclovir (PO): 20 mg/kg q6hr to max of 800 mg q6hr, for 5 days

valacyclovir (PO): (> 2 yo) 20 mg/kg (max 1,000 mg) q 8hr for 5 days; better bioavailability

antiviral therapy decreases the duration of sx and the likelihood of postherpetic neuralgia

Question 4

How long should pregnancy be delayed after a varicella vaccination?

Answer 4

1 month after vaccination

Question 5

Can pregnant women receive the varicella vaccine? What about breastfeeding women?

Answer 5

No

the varicella vaccine is CI in pregnant women. women found to be nonimmune during pregnancy should be counseled to avoid exposure to chickenpox and to report exposure immediately

varicella vaccine is considered safe in breastfeeding women

Question 6

If a pregnant woman is exposed to varicella, are they candidates for varicella zoster immune globulin?

Answer 6

yes

susceptive pregnant women who are exposed to varicella are candidates for varicella zoster immune globulin