Chickenpox is clinically characterized by the presence of active and healing lesions in all stages of development within affected locations. Lesions characteristically heal without scarring, although excoriation or secondary bacterial superinfection predisposes to scar formation.
Childhood chickenpox is usually not heralded by a prodrome; it begins with the onset of an exanthem. In adults and adolescents, chickenpox may be preceded by a prodrome of nausea, myalgia, anorexia, and headache. The triad of rash, malaise, and a low-grade fever can signal disease onset, though the typical patient is infectious for 1-2 days prior to the development of rash.
Secondary bacterial infection of skin lesions, manifesting as impetigo, cellulitis, and erysipelas, is the most frequent complication in otherwise healthy children. Central nervous system complications of primary varicella-zoster virus (VZV) infection may occur, albeit very rarely.
Five major hemorrhagic complications have been described:
Malignant chickenpox with purpura
These syndromes have variable courses, with febrile purpura being the most benign and having an uncomplicated outcome. In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality exceeding 70%.
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