Eczema Vaccinatum: Symptoms, Diagnosis, and Treatment

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Eczema vaccinatum is a rare complication of the smallpox vaccination. It affects people with eczema, and serious cases can be fatal.

However, smallpox is no longer considered a public health threat, and routine smallpox vaccinations against smallpox stopped in the United States in 1972.

Today, the vaccination is only given to select members of the military, select members of the Department of Defense, and some people who work in biological laboratories. This means eczema vaccinatum is very rare, but knowing the symptoms of this condition is still important. Treatment is essential for eczema vaccinatum, and it’s best to start treatment right away.

Read on to learn more about this rare condition.

Eczema vaccinatum (EV) is a complication that sometimes occurs as a result of the smallpox vaccination. This complication only occurs in people who have eczema.

EV causes a painful rash, fever, and other symptoms. It is most dangerous to young children and always requires medical treatment. EV can be fatal in severe cases.

The symptoms of EV are highly noticeable. People with EV generally become very sick, very quickly. Symptoms occur after receiving a smallpox vaccine or after coming in contact with someone who received the vaccine. Symptoms include:

Some forms of the smallpox vaccine contain a live virus. This viral material is normally harmless. Most people who receive the smallpox vaccine have mild symptoms such as a sore arm or a slight fever for a day or two but have no long-term or serious complications. In fact, EV doesn’t occur as a result of the injected live virus. Rather, EV develops when the live virus gets into the body through your skin.

Eczema damages the skin’s natural barriers. People with eczema are at higher risk of bacterial, fungal, and viral skin infections. These infections may be more complex for people with eczema than standard cases and they require additional or specialized treatments. Similarly, people with eczema can develop an infection if the live virus contained in the smallpox vaccine touches their skin. This can happen if a person with eczema:

  • touches the site of their smallpox vaccination before it’s fully healed
  • touches the bandage that was covering their vaccination site
  • touches an item that came in contact with an unhealed vaccination site such as clothing, towels, or washcloths
  • itches their vaccination site
  • touches another person’s vaccination site, vaccination bandage, and personal items such as clothing, towels, or washcloths

Sometimes, people with eczema can spread the smallpox vaccine virus without realizing it. For instance, a person with eczema could remove their bandage believing the site is completely healed. Later, they could apply their standard nightly lotion or corticosteroid cream. If the vaccination site wasn’t fully healed, applying lotion can spread the virus, and can even help it penetrate the skin.

Doctors can normally diagnose EV during a single exam. The skin lesions that develop are very distinctive.

Keep in mind that EV only develops in people with eczema who’ve come in contact with the smallpox vaccine, and the smallpox vaccine is very rarely given in modern times. This allows doctors to either rule out or confirm EV quickly.

The Centers for Disease Control and Prevention (CDC) and the United States Food and Drug Administration (FDA) have approved and currently recommend the use of vaccinia immune globulin (VIG) as a treatment for EV.

This treatment is given by injection over the course of several days. Treatment is most successful when it is started early. In some cases, additional treatment might be needed. For instance, antibiotics are sometimes prescribed to prevent or treat bacterial infections or open lesions.

EV is extremely rare. The biggest risk factor is having eczema and receiving the smallpox vaccine.

The smallpox vaccine is not recommended for people with eczema or for people who share households with people with eczema. This includes people who haven’t had recent eczema flare-ups. For instance, adults who no longer have eczema flare-ups, but who had childhood eczema, are not candidates for the smallpox vaccine.

It’s important to note that some people with other chronic skin diseases, such as Darier’s disease, are also not candidates for the smallpox vaccine.

Talk with a medical professional if you have any chronic skin condition and if you, or anyone in your household, need a smallpox vaccine for any reason. There are alternative smallpox vaccines available for people with immune conditions like eczema and HIV.

In the United States, the smallpox vaccine is only required in a few specific professional settings, including:

  • military members
  • Department of Defense (DOD) employees
  • laboratory workers

EV can be fatal in severe cases. EV is most dangerous for young children. EV is infectious and could spread to others while skin lesions are open.

On average, it takes 21 days for scabs to form and for lesions to begin falling off. However, eczema can make skin healing a longer and slower process.

Eczema vaccinatum is a rare condition. It develops when the smallpox vaccination gets into the skin of people with eczema.

The live virus can travel through the damaged skin barriers and cause someone to become very ill. It’s important for someone with EV to get treatment right away because severe cases of EV can be fatal.

However, the smallpox vaccine isn’t routinely given in modern times. Only certain military, Department of Defense, and laboratory workers receive the vaccine. Additionally, versions of the vaccine for people who are immunocompromised, including people with eczema, have been developed.

These factors make EV a very rare condition, but it is a serious one. If you have eczema, it’s important to understand EV and to keep yourself safe if you ever do come in contact with the smallpox vaccine.

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