Facial scarring after varicella. A comparison with variola major and variola minor

Scars are frequently found as late sequelae in individuals affected by the 2022 mpox outbreak

BACKGROUND

The 2022 mpox outbreak continues, and while progress has been made in prevention strategies and potential treatment options, data on late sequelae following mpox are scarce.

OBJECTIVE

This analysis aimed to assess the incidence of scar formation in individuals affected by the 2022 mpox outbreak.

METHODS

All individuals diagnosed with mpox at the Department of Dermatology at the Medical University of Vienna in 2022 were included in this analysis. Follow-up data were collected throughout November 2023. 'Scar formation' was defined as having at least one scar at the former active mpox lesions.

RESULTS

At our clinic, 28 cases of mpox presented between June 2022 and October 2022 and exclusively occurred in men who have sex with men (100%, 28/28), of whom 46% (13/28) were living with HIV, and 32% (9/28) were using pre-exposure prophylaxis (PrEP). Secondary bacterial infection of mpox lesions was suspected in six individuals, and all received systemic antibiotics. Overall, 26 were followed up in November 2023 after a median time of 15 months, and scar formations were found in 43% of cases.

CONCLUSIONS

Our data provide insights into the late yet cumulating disease burden caused by the 2022 mpox outbreak. Highly effective prevention strategies are warranted to overcome the mpox epidemic and its potential late sequelae.

Chemical reconstruction of skin scars therapy using 100% trichloroacetic Acid in the treatment of atrophic facial post varicella scars: a pilot study

Context:

Chickenpox (varicella) is a common viral disease caused by Varicella zoster virus. Facial atrophic scars after varicella infection are not uncommon and pose a cosmetic problem. Like atrophic scars of other aetiologies, they are a difficult condition to treat. There are not enough references in the literature regarding efficient treatment of post varicella scars. High strength Trichloroacetic acid (TCA), which is known to cause dermal collagen remodelling, was used to treat varicella scars in the present study.

Aims:

The study was undertaken to assess the efficiency of Chemical Reconstruction of Skin Scars (CROSS) technique using 100% TCA in the treatment of atrophic facial post varicella scars. Settings and Design: Open label, pilot study.

Materials and Methods:

A total of 16 patients with atrophic facial post varicella scars were treated by focal application of 100% TCA solution by pressing down upon the scar surface by a toothpick (CROSS technique). Total 4 sittings were given at 2 weekly intervals and the results evaluated after 3 months of follow-up. Statistical analysis was carried out using Fischer's exact t-test.

Results:

All of the 13 patients who completed the study showed good clinical improvement, with 69% patients grading the response as excellent (>75%) improvement, whereas the rest 31% patients reporting good (51-75%) improvement. No significant complications were seen in any patient.

Conclusions:

CROSS technique using 100% TCA is a safe, cheap and effective therapy for the treatment of post varicella scars.

Laser Resurfacing of Smallpox Scars

BACKGROUND

At the beginning of the twentieth century, smallpox affected every continent and country in the world, but over the first half of the twentieth century this disease was eliminated in most countries, including Korea, thanks to the World Health Organization's eradication program. Most survivors of smallpox have facial scars with a distinct cobblestone appearance. Though most smallpox scar patients want smooth skin, it is difficult to achieve good results with dermabrasion or chemical peeling. Recently, with advances in laser technology, laser resurfacing has become more effective and safer than conventional methods because of its depth control precision.

METHODS

Between September of 1996 and August of 2001, 76 patients with significant smallpox scars were treated with a high-powered carbon dioxide laser at Korea University's Anam Medical Center. Different resurfacing methods, such as even-depth resurfacing, the shoulder technique, and the laser punch-out method, were applied according to the depth and pattern of the scars.

RESULTS

The authors found that 54 patients (71 percent) had excellent or good results. The sharply demarcated margins of the smallpox scars faded out, and the depth and width of the depressed scars improved in most patients. Only seven patients sustained hypertrophic scarring after laser resurfacing, but this was resolved by intradermal triamcinolone injections. Prolonged erythema occurred in six patients (7.9 percent) and hyperpigmentation occurred in 15 (19.7 percent), but the erythema disappeared spontaneously and the hyperpigmentation could be readily managed with postoperative skin care.

CONCLUSION

Laser resurfacing was found to be a useful treatment method for smallpox scarring.

Seroprevalence of varicella zoster and rubella antibodies among rural populations of the Chaco region, south-eastern Bolivia

OBJECTIVE

To determine the seroprevalence of antibodies against varicella zoster virus (VZV) and rubella virus among the population of two rural areas, Camiri and Villa Montes, Chaco region, south-eastern Bolivia.

METHODS

In a cross-sectional study, serum samples from randomly selected subjects were screened for VZV- and rubella antibodies using enzyme-linked immunosorbent assay (ELISA).

RESULTS

The prevalence of VZV antibodies was 80% (391 of 489). No significant differences were observed between genders and study areas. The prevalence increased with age with a seropositivity rate of 21.2% in the 1-4-year-old children, 56.9% in the 5-9 age group and 83.7% in the 10-14 age group, and reached 98.2% in over 45-year olds. The prevalence of rubella virus antibodies was 76.9% (377 of 490), without significant differences between genders and study areas. Similar to the trend observed for VZV antibodies, the seroprevalence increased with age with a seropositivity rate of 18.1% in the 1-4-year-old children, 53.9% in the 5-9 age group and 78.4% in the 10-14 age group, and reached 94.7% in over 45-year-old subjects. Among the 95 women of childbearing age (15-44 years) the susceptibility rate was 11.6%.

CONCLUSIONS

A common seroimmunological profile was evidenced for the two infections. The age-specific profile of VZV seropositivity differs from that reported for other tropical countries where higher median age of seroconversion and lower seroprevalence among adults are observed. Data concerning the prevalence of immunity to rubella may be useful to evaluate the impact of the recently introduced rubella immunization programme.

Scarring resulting from chickenpox

Nine hundred and eighty-six children (519 boys, 467 girls) who had chickenpox at least 1 year previously were examined for the presence of scars resulting from this disease. Ninety-six (18.5%) boys and 88 (18.8%) girls had chickenpox scars, giving rise to an overall prevalence of 18.7%. The scars were found on the face in 75 (40.8%), neck 2 (1.1%), shoulders 8 (4.3%), upper limbs 15 (8.2%), anterior thorax 50 (27.2%), abdomen 106 (57.6%), back 65 (35.3%), buttocks 9 (4.9%), and lower limbs 12 (6.5%) affected children. The mean number of scars in the 184 children was 2.8 (standard deviation 1.9). The scars were hyperpigmented in 32, hypopigmented in 160, depressed in 38, and hypertrophic in 32 children. Keloids were noted in two children.

Social epidemiology of chickenpox in two British national cohorts

STUDY OBJECTIVE

To provide a quantitative description of factors independently predictive of reported chickenpox infections in two national cohorts of British children.

DESIGN

Longitudinal cohort study design employing logistic regression analysis of data obtained in the 1970 British Births Survey (later to become the Child Health and Education Study, CHES), and the 1958 British Perinatal Mortality Survey (later to become the National Child Development Survey, NCDS).

SETTINGS

One-week birth cohorts covering the whole of the United Kingdom.

PARTICIPANTS

Data were obtained from questionnaires administered to the carers of 10,196 children born in the UK between 5 and 11 April 1970 (CHES) and 10,927 children born in the UK between 3 and 9 March 1958 (NCDS). These numbers consist of the whole of the surviving cohorts excluding those for whom data were incomplete.

MEASUREMENTS

Biological, social, and medical factors in the parents and children, as recorded by the child's principle carer or from clinical notes.

MAIN RESULTS

Chickenpox by the age of 10 years was reported to be more common in the children of advantaged families (higher social class, higher parental education levels), with a higher prevalence in those parts of the United Kingdom normally associated with affluence, such as the South East and South West of England, and lower rates in Wales and Scotland. Chickenpox by 10 years was also associated with more crowding in the home. A similar but less marked pattern occurred for chickenpox by the age of 11 years in the 1958 NCDS cohort. This social distribution apparently reflected overall rather than age-specific susceptibility.

CONCLUSIONS

The national and international pattern of chickenpox epidemiology indicate that both social and climatological factors may be important in defining groups at risk. Further research is indicated if a vaccination service is to be implemented in this country.

Herpes zoster in African patients: an early manifestation of HIV infection

During a 3-month period, 131 cases of herpes zoster were diagnosed in Kigali, Rwanda. There were 46 female and 85 male patients. Mean age was 29 years (range 1-66). An unusually high proportion of patients presented with cranial and sacral nerve localisation of their cutaneous lesions. 55/131 patients (42%) had involvement of more than one dermatome. None of the patients had an underlying condition known to favour herpes zoster. 120/131 (92%) had antibodies to HIV detected by an immunoenzymatic assay (EIA) and indirect immunofluorescence. 92/125 adult patients (74%) had no sign or symptom related to HIV infection other than herpes zoster. This study suggests that herpes zoster in Central Africa is an early and readily detectable manifestation of HIV-induced immunosuppression.

The smallpox story: life and death of an old disease

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