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Skin-nontumor / Clinical Dermatology

Infectious disorders

Smallpox vaccination

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 7 November 2010, last major update September 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

Definition
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● Diffuse, pruritic, erythematous macules and papules that usually occur 7-11 days (range, 2 days to 7 weeks) after routine smallpox vaccination

Clinical features
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● Serious but uncommon complications of smallpox vaccination include eczema vaccinatum, vaccinia necrosum, generalized vaccinia and encephalitis (Centers for Disease Control)
● Less serious but more common complications include keloid, contact dermatitis, erythema multiforme, pityriasis rosea, granuloma annulare and vesicular spongiotic dermatitis with eosinophils (Arch Dermatol 2010;146:656)

Treatment
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● Symptomatic

Clinical images
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Normal reaction

Normal "robust" reaction

Hyperemic and indurated band extending from the vaccination site

Vaccinia necrosum

Micro description
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● Smallpox vaccination: possible features include eczema vaccinatum, vaccinia necrosum, generalized vaccinia, keloid, contact dermatitis, erythema multiforme, pityriasis rosea, granuloma annulare and vesicular spongiotic dermatitis with eosinophils
● Smallpox infection (historical features-smallpox has now been eradicated): variable degree of hyperkeratosis and acanthosis, ballooning degeneration of keratinocytes, cytoplasmic eosinophilic inclusion bodies and dermal chronic inflammatory cell infiltrate

Micro images
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Various images

Additional references
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● Arch Pathol Lab Med 2004;128:1173, Am Fam Physician 2006;74:145)

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Smallpox vaccination

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