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Dermatology Library

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Varicella (chicken pox):

The reason varicella is called chickenpox has nothing to do with chickens. Chickenpox got its nickname because the blisters look like chick peas. Varicella, or chickenpox, is one of the most common childhood diseases. It is caused by the varicella-zoster virus. Most people in the United States get chickenpox while they are still children. Until the late 1990's there were about 4 million cases a year. But now that people are using varicella vaccine, that number has begun to drop. The most recognizable feature of chickenpox is an itchy rash all over the body. Children with chickenpox can also be drowsy and have a fever.

Chickenpox can be spread very easily from person to person. It is spread through the air, by coughing or sneezing, or even talking. It can also be spread by contact with fluid from the blisters. It usually takes 2-3 weeks from the time a child is exposed to chickenpox virus until he or she becomes ill. The disease is contagious from 1 or 2 days before the rash appears until all the blisters are dried up, which usually takes 4 to 5 days.

Chickenpox is usually a mild disease, uncomfortable but not dangerous. Still, serious problems do occur. The blisters can become infected, and some children get encephalitis (infection of the brain). Of every 100,000 infants under one year old who get chickenpox, about 4 die. For older children, 1 to 14 years old, about 1 in 100,000 dies. If a woman gets chickenpox just before or after giving birth, her baby can get very sick, and about 1 in 3 of these children die if they are not treated quickly.

Even when chickenpox is not serious, it can create problems for the family because the parents may have to miss work to care for the sick child. About 1 child out of 500 who get chickenpox must be hospitalized. For adults who get chickenpox, 1 in 50 must be hospitalized.

After a person has chickenpox, the virus stays in the body. Years later, it can cause a painful disease called zoster, or shingles.

Veins:

Spider veins are small enlarged superficial blood vessels that appear red or blue. They commonly occur on the legs, but frequently occur on the face or elsewhere. These dilated blood vessels may be short, unconnected lines each about the size of a large hair or connected in a matted, "sunburst" pattern. They may also look like a spider web or a tree with branches. Sometimes, they occur in a small area and aren't very noticeable, or they can cover a large area of skin and be quite unattractive. Larger dilated blood vessels called varicose veins may be raised above the skin surface. They may occur along with spider veins. Patients can have pain, ranging from a dull throbbing pain to a burning sensation. The larger vessels are more likely to cause discomfort, although smaller blue veins have been shown to cause pain. If spider veins are unsightly or uncomfortable, they can be treated with laser or by injection of a solution that will cause them to disappear or become much smaller. There is about a 50 - 90 percent chance for a greatly improved appearance.

Verruca Vulgaris (Warts):

Verruca Vulgaris Warts are common, non-cancerous growths caused by the human papilloma virus (HPV). There are more than 100 types of HPV. Most HPV types cause a specific type of wart and favor certain anatomical locations. Warts are a live virus and spread by contact. Trauma or injury to skin allows warts to spread more easily. People with a weakened or compromised immune system may also develop the virus more easily.

Verruca Vulgaris Generally warts are skin-colored, rough, may be flat or raised, and have a cauliflower appearance. Small black dots caused by blood vessels may be visible within the wart. The most common types of warts are common warts, foot (plantar) warts, and flat warts. Common warts usually occur on the fingers and the back of the hands. They are most common along the nails where people develop hang nails or bite their nails. Foot or plantar warts occur on the soles of the feet. These are often painful due to the pressure caused by walking. Flat warts are small and smooth, occurring in large groups of 20-100 warts. They are common on children’s faces, and on the beard of men and legs of women due to shaving.

Most warts will resolve on their own in months to years without treatment. If warts are bothersome or painful, there are several treatment options. An over-the-counter treatment option is painting on salicylic acid, gel, or solution. This treatment is very slow and often does not give desired results. Cryotherapy can be used to freeze the warts with liquid nitrogen every 2-3 weeks. This treatment is more painful and may leave scarring. Electrosurgery or burning of the wart can also be used but this may also leave scarring. Foot or plantar warts may require surgical excision if they are large and painful. There are also topical creams that can be used to treat warts, but they are often expensive.

Submitted by: Nitra H. Cole, MSN, ARNP, NP-C

Vitiligo:

Vitiligo Vitiligo is a pigmentation disorder that results from loss of pigment within skin cells that make pigment (melanocytes). It usually begins with white patches of skin developing. The most common sites are the face, lips, hands, arms, legs, and genital areas, but vitiligo can develop anywhere on the body. It may remain localized or may spread to depigment the whole body. It is more noticeable in darker skinned people. Vitiligo also affects the hair that grows in the affected area and it also turns white. The retina of the eye may be affected and lose pigment.

Vitiligo The specific cause of vitiligo is not known, but it is thought to be an autoimmune disorder where the body develops antibodies against its own pigment cells. Most people that develop vitiligo are in good health, but it is common for vitiligo to occur with other autoimmune diseases. Vitiligo develops equally in men and women, half of all cases develop before age 20 and most all cases develop by age 40. Approximately 30 percent of individuals that develop vitiligo have an affected family member.

Treatment of vitiligo is difficult, often unsuccessful, and most options are considered aggressive. The simplest and safest treatment is applying topical steroid cream or topical immunomodulators. This may be helpful in repigmenting small areas. More aggressive treatment options include PUVA therapy, grafting, or depigmentation. PUVA therapy involves taking a medication called psoralen. This medication makes the skin more sensitive to ultraviolet light. The skin is treated with ultraviolet light two times a week for a least one year. About 50% of the body may regain pigment, while the hands and feet respond poorly. Common side effects include severe sunburn and blistering or hyperpigmentation of the skin. Grafting involves transplanting normal pigmented skin to white areas. It is often painful and leaves scarring. Depigmentation therapy is used to remove remaining pigment from the body. It involves application of hydroquinone cream for at least one year and causes permanent pigment loss.

People with vitiligo are more sensitive to sun exposure. It is important to minimize sun exposure and to use sunscreen that protects against UVA and UVB ultraviolet light. Some patients use cosmetics to help disguise vitiligo. Make-up or self-tanning creams and lotions are effective in concealing vitiligo.

Submitted by: Nitra H. Cole, MSN, ARNP, NP-C