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Eczema vaccinatum is a rare complication of smallpox vaccination that causes a widespread rash and blisters in people with underlying skin conditions. It can lead to serious complications and hospitalization. Treatment may include vaccination with vaccine immunoglobulin and supportive care. Smallpox vaccination is no longer necessary except for certain individuals, and those with a history of skin problems should avoid vaccination. Early treatment is important to limit permanent skin damage.
Eczema vaccinatum is an unusual complication of smallpox vaccination seen in people with underlying skin conditions such as eczema and impetigo. In these patients, exposure to the vaccine causes a widespread rash of blisters and skin irritation. There is a risk of developing serious complications, and patients with this condition may need to be hospitalized for treatment. This condition is not smallpox, but rather an adverse reaction to the smallpox vaccine.
There are two ways people can develop eczema vaccinatum. The first is through direct inoculation with smallpox vaccine, and the other is through contact with someone who has recently been inoculated, who can shed small amounts of vaccinia as they recover from the vaccine. In either case, a rash begins, accompanied by fluid-filled bumps, and can spread rapidly throughout the body. If the patient was unaware of the underlying skin condition, the reaction can be an unexpected and very unpleasant surprise.
Treatment of eczema vaccinatum may include vaccination with vaccine immunoglobulin to stop the reaction, along with supportive care in the ICU to address problems such as high fever, eye damage, and breathing difficulties. Fluids may be needed, and some patients need mechanical ventilation to deal with breathing problems. With inpatient care, a patient can recover, although some small scarring may be left as a legacy of the rash, especially if the patient scratched or scratched during the episode.
With the global eradication of smallpox a significant public health victory, the need for smallpox vaccinations is very low. Vaccines may be recommended for some members of the military, as well as researchers who come into contact with the world’s remaining smallpox stocks. In individuals with a history of skin problems, vaccination is contraindicated, and individuals to be vaccinated should avoid contact with unvaccinated family members with skin conditions while they recover from vaccination. Eczema vaccinatum can be an especially serious concern for newborns. Before receiving a smallpox vaccine, people should review their medical history and ask about any special risks to family members.
Doctors rarely see this condition, thanks to the limited number of smallpox vaccinations administered. People who need smallpox vaccines or who live with people who have been vaccinated should be alert to potential complications of vaccination and seek medical treatment promptly if conditions such as eczema vaccinatum develop. Early treatment can greatly improve the prognosis and limit permanent skin damage.
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