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Eczema vaccinatum

Last edited: 4/13/2026

Overview

Eczema vaccinatum is a rare but severe complication of smallpox vaccination in individuals with atopic dermatitis, characterized by widespread vaccinia infection triggered by the live virus from the vaccine. 25

Diagnosis

  • Clinical presentation of widespread vesiculopustular rash in patients with pre-existing atopic dermatitis following vaccination. 25
  • No specific diagnostic tests; clinical history and physical examination are crucial. 25

    • Management

  • Immediate discontinuation of vaccination. 25
  • Administration of vaccinia immune globulin (VIG) for severe cases. 25
  • Use of systemic antiviral agents like cidofovir or tecovirimat in refractory cases, under specialist guidance. 25
  • Supportive care including wound care and management of secondary infections. 25

    • Special Populations

  • No specific guidelines provided in the abstracts for special populations such as pregnancy, pediatrics, or elderly patients regarding eczema vaccinatum. 25

    • Key Recommendations

  • Discontinue vaccination immediately upon suspicion of eczema vaccinatum in individuals with atopic dermatitis. (Evidence: Expert opinion) 25
  • Administer vaccinia immune globulin (VIG) for severe cases to manage the systemic spread of vaccinia virus. (Evidence: Expert opinion) 25
  • Consider systemic antiviral therapy such as cidofovir or tecovirimat for refractory cases under specialist supervision. (Evidence: Expert opinion) 25

    • References

    1 Wollenberg A, Kinberger M, Arents B, Aszodi N, Barbarot S, Bieber T et al.. European Guideline (EuroGuiDerm) on atopic eczema: Living update. Journal of the European Academy of Dermatology and Venereology : JEADV 2025. link 2 Argenziano G, Cusano F, Corazza M, Amato S, Amerio P, Naldi L et al.. Italian S3-Guideline on the treatment of Atopic Eczema - First Update, adapted from EuroGuiDerm by the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Occupational Dermatology (SIDAPA). Italian journal of dermatology and venereology 2024. link 3 Ying G, Koch K. General practitioner prescription patterns for atopic eczema in children-Are they affected by telemedicine advice?. The Australasian journal of dermatology 2024. link 4 Haft MA, Park HH, Lee SS, Sprague JM, Paller AS, Cotton CH et al.. Diagnosis and Management of Pediatric Chronic Hand Eczema: The PeDRA CACHES Survey. Paediatric drugs 2023. link 5 Tawfik SS, Thomas BR, Kelsell DP, Grigg J, O'Toole EA. Dermatology Quality of Life Index scores in Bangladeshi patients with atopic eczema and their families in East London. The British journal of dermatology 2023. link 6 Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S et al.. European guideline (EuroGuiDerm) on atopic eczema: part I - systemic therapy. Journal of the European Academy of Dermatology and Venereology : JEADV 2022. link 7 Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S et al.. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. Journal of the European Academy of Dermatology and Venereology : JEADV 2022. link 8 Musters AH, Mashayekhi S, Harvey J, Axon E, Lax SJ, Flohr C et al.. Phototherapy for atopic eczema. The Cochrane database of systematic reviews 2021. link 9 Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM et al.. Safety of topical corticosteroids in atopic eczema: an umbrella review. BMJ open 2021. link 10 Leshem YA, Chalmers JR, Apfelbacher C, Furue M, Gerbens LAA, Prinsen CAC et al.. Measuring atopic eczema symptoms in clinical practice: The first consensus statement from the Harmonising Outcome Measures for Eczema in clinical practice initiative. Journal of the American Academy of Dermatology 2020. link 11 Sach TH, McManus E, Levell NJ. Understanding economic evidence for the prevention and treatment of atopic eczema. The British journal of dermatology 2019. link 12 Rönsch H, Apfelbacher C, Brans R, Matterne U, Molin S, Ofenloch R et al.. Which outcomes have been measured in hand eczema trials? A systematic review. Contact dermatitis 2019. link 13 Lloyd-Lavery A, Rogers NK, Hatfield SJ, Grindlay D, Barnett R, Thomas KS. What's new in atopic eczema? An analysis of systematic reviews published in 2014. Part 2. Treatment and prevention. Clinical and experimental dermatology 2017. link 14 Carlsson A, Svensson Å, Anderson CD, Baranovskaya I, Hindsén-Stenström M, Holt I et al.. Scoring of Hand Eczema: Good Reliability of Hand Eczema Extent Score (HEES). Acta dermato-venereologica 2017. link 15 Kakande B, Gumedze F, Hlela C, Khumalo NP. Focus on the Top Ten Diagnoses Could Reduce Pediatric Dermatology Referrals. Pediatric dermatology 2016. link 16 Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J et al.. Guidelines for diagnosis, prevention and treatment of hand eczema. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2015. link 17 Schmitt J, Apfelbacher C, Spuls PI, Thomas KS, Simpson EL, Furue M et al.. The Harmonizing Outcome Measures for Eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology. The Journal of investigative dermatology 2015. link 18 Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J et al.. Guidelines for diagnosis, prevention and treatment of hand eczema--short version. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2015. link 19 Naidoo RJ, Williams HC. Therapeutic use of stories for children with atopic eczema and other chronic skin conditions. Pediatric dermatology 2013. link 20 Baker M. NICE guidance points the way to tackling eczema in children. Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association 2013. link 21 How CH, Quah JH, Koh MJ. Simply eczema. Singapore medical journal 2013. link 22 Proudfoot LE, Powell AM, Ayis S, Barbarot S, Baselga Torres E, Deleuran M et al.. The European TREatment of severe Atopic eczema in children Taskforce (TREAT) survey. The British journal of dermatology 2013. link 23 Pfab F, Valet M, Napadow V, Tölle TR, Behrendt H, Ring J et al.. Itch and the brain. Chemical immunology and allergy 2012. link 24 Soost S, Abdollahnia M, Kostev K, Worm M. Topical therapy of hand eczema - analysis of the prescription profile from dermatologists in private practice. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2012. link 25 Hon KL, Nip SY, Cheung KL. A tragic case of atopic eczema: malnutrition and infections despite multivitamins and supplements. Iranian journal of allergy, asthma, and immunology 2012. link 26 Darsow U, Forer I, Ring J. Allergen-specific immunotherapy in atopic eczema. Current allergy and asthma reports 2011. link 27 Schopf T, Flytkjær V. Doctors and nurses benefit from interprofessional online education in dermatology. BMC medical education 2011. link 28 Ayliffe V. Clinical features and management of atopic eczema in children. Paediatric nursing 2009. link 29 Kownacki S. The importance of emollients in treating the increasing incidence of atopic eczema. Nursing times 2009. link 30 Moore EJ, Williams A, Manias E, Varigos G, Donath S. Eczema workshops reduce severity of childhood atopic eczema. The Australasian journal of dermatology 2009. link 31 Schmitt J, Kirch W, Meurer M. Effects of the introduction of the German "Praxisgebühr" on outpatient care and treatment of patients with atopic eczema. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2009. link 32 Coenraads PJ. Hand eczema is common and multifactorial. The Journal of investigative dermatology 2007. link 33 Schnopp C, Rad R, Weidinger A, Weidinger S, Ring J, Eberlein B et al.. Fox-P3-positive regulatory T cells are present in the skin of generalized atopic eczema patients and are not particularly affected by medium-dose UVA1 therapy. Photodermatology, photoimmunology & photomedicine 2007. link 34 Heine G, Schnuch A, Uter W, Worm M. Type-IV sensitization profile of individuals with atopic eczema: results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG). Allergy 2006. link 35 Moore E, Williams A, Manias E, Varigos G. Nurse-led clinics reduce severity of childhood atopic eczema: a review of the literature. The British journal of dermatology 2006. link 36 Turjanmaa K, Darsow U, Niggemann B, Rancé F, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy 2006. link 37 Allam JP, Bieber T, Novak N. Recent highlights in the pathophysiology of atopic eczema. International archives of allergy and immunology 2005. link 38 Holm EA, Esmann S, Jemec GB. Patient education and morbidity in atopic eczema. Dermatology nursing 2005. link 39 Greaves MW. Antihistamines in dermatology. Skin pharmacology and physiology 2005. link 40 Radley K. NICE guidance on use of topical corticosteroids in atopic eczema. Nursing times 2004. link 41 Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients' perspective. Archives of dermatology 2004. link 42 Winau F, Westphal O, Winau R. Paul Ehrlich--in search of the magic bullet. Microbes and infection 2004. link 43 Robinson J. Caring for Bangladeshi children with atopic eczema. The journal of family health care 2002. link 44 Friedmann PS. The pathogenesis of atopic eczema. Hospital medicine (London, England : 1998) 2002. link 45 Chinn DJ, Poyner T, Sibley G. Randomized controlled trial of a single dermatology nurse consultation in primary care on the quality of life of children with atopic eczema. The British journal of dermatology 2002. link 46 Jackson K. Nursing assessment and care of children with atopic eczema. Professional nurse (London, England) 2001. link 47 Buchanan PI. Behavior modification: a nursing approach for young children with atopic eczema. Dermatology nursing 2001. link 48 Shum KW, Lawton S, Williams HC, Docherty G, Jones J. The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 2: audit of service process. The British journal of dermatology 2000. link 49 Shum KW, Lawton S, Williams HC, Docherty G, Jones J. The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 3: audit of service outcome. The British journal of dermatology 2000. link 50 Shum KW, Lawton S, Williams HC, Docherty G, Jones J. The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 1: audit of service structure. The British journal of dermatology 1999. link 51 Twitchen LJ, Lowe AJ. Atopic eczema and wet-wrap dressings. Professional nurse (London, England) 1998. link 52 Arkwright PD, Patel L, David TJ. Dietary management of atopic eczema: is this justified?. Hospital medicine (London, England : 1998) 1998. link 53 Brehler R, Hildebrand A, Luger TA. Recent developments in the treatment of atopic eczema. Journal of the American Academy of Dermatology 1997. link80284-8) 54 Donald S. Know how. Wet wraps in atopic eczema. Nursing times 1997. link 55 Lynn SE, Lawton S, Newham S, Cox M, Williams HC, Emerson R. Managing atopic eczema: the needs of children. Professional nurse (London, England) 1997. link 56 Lawton S, Lynn SE, Newham S, Cox M, Williams HC, Emerson R. Managing atopic eczema: running a specialist clinic. Professional nurse (London, England) 1997. link 57 Fischer G. Compliance problems in paediatric atopic eczema. The Australasian journal of dermatology 1996. link 58 Koblenzer PJ. Parental issues in the treatment of chronic infantile eczema. Dermatologic clinics 1996. link70369-7) 59 Forsdyke H, Watts J. Skin care in atopic eczema. Professional nurse (London, England) 1994. link 60 Bridgman A. Management of atopic eczema in the community. Health visitor 1994. link 61 Cronin E, McFadden JP. Patients with atopic eczema do become sensitized to contact allergens. Contact dermatitis 1993. link 62 Jaafar RB, Pettit JH. Atopic eczema in a multiracial country (Malaysia). Clinical and experimental dermatology 1993. link 63 Heyer G. Abnormal cutaneous neurosensitivity in atopic skin. Acta dermato-venereologica. Supplementum 1992. link 64 Morgan JM, Weller R, Adams SJ. Onycholysis in a case of atopic eczema treated with PUVA photochemotherapy. Clinical and experimental dermatology 1992. link 65 McComb JL, King CM. Atopic eczema and orthodontic headgear. Dental update 1992. link 66 Goodyear HM, Harper JI. Atopic eczema, hyponatraemia, and hypoalbuminaemia. Archives of disease in childhood 1990. link 67 Devlin J, David TJ. Intolerance to oral and intravenous calcium supplements in atopic eczema. Journal of the Royal Society of Medicine 1990. link 68 Hájek P, Jakoubek B, Radil T. Gradual increase in cutaneous threshold induced by repeated hypnosis of healthy individuals and patients with atopic eczema. Perceptual and motor skills 1990. link 69 Hughes BR, Cunliffe WJ. Rippled hyperpigmentation resembling macular amyloidosis--a feature of atopic eczema. Clinical and experimental dermatology 1990. link 70 Pike MG, Chang CL, Atherton DJ, Carpenter RG, Preece MA. Growth in atopic eczema: a controlled study by questionnaire. Archives of disease in childhood 1989. link 71 Ruzicka T. Leukotrienes in atopic eczema. Acta dermato-venereologica. Supplementum 1989. link 72 Barba A, Schena D, Andreaus MC, Faccini G, Pasini F, Brocco G et al.. Intestinal permeability in patients with atopic eczema. The British journal of dermatology 1989. link 73 Ionescu G, Kiehl R. Plasma catecholamine levels in severe atopic eczema. Allergy 1988. link 74 Ionescu G, Kiehl R. Monoamine and diamine oxidase activities in atopic eczema. Allergy 1988. link 75 David TJ, Ewing CI. Atopic eczema and preterm birth. Archives of disease in childhood 1988. link 76 Svensson A. Hand eczema: an evaluation of the frequency of atopic background and the difference in clinical pattern between patients with and without atopic dermatitis. Acta dermato-venereologica 1988. link 77 Andersen LB, Thestrup-Pedersen K. Sweat pore density on the fingertips of atopic patients. The British journal of dermatology 1987. link 78 David TJ, Richmond SJ, Bailey AS. Serological evidence of herpes simplex virus infection in atopic eczema. Archives of disease in childhood 1987. link 79 Midelfart K, Stenvold SE, Volden G. Combined UVB and UVA phototherapy of atopic eczema. Dermatologica 1985. link 80 Cronin E. Clinical patterns of hand eczema in women. Contact dermatitis 1985. link 81 Ukabam SO, Mann RJ, Cooper BT. Small intestinal permeability to sugars in patients with atopic eczema. The British journal of dermatology 1984. link 82 David TJ, Waddington E, Stanton RH. Nutritional hazards of elimination diets in children with atopic eczema. Archives of disease in childhood 1984. link 83 Atherton DJ, Soothill JF, Elvidge J. A controlled trial of oral sodium cromoglycate in atopic eczema. The British journal of dermatology 1982. link

    Original source

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      European Guideline (EuroGuiDerm) on atopic eczema: Living update. — Wollenberg A, Kinberger M, Arents B, Aszodi N, Barbarot S, Bieber T et al. Journal of the European Academy of Dermatology and Venereology : JEADV (2025)
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      Italian S3-Guideline on the treatment of Atopic Eczema - First Update, adapted from EuroGuiDerm by the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Occupational Dermatology (SIDAPA). — Argenziano G, Cusano F, Corazza M, Amato S, Amerio P, Naldi L et al. Italian journal of dermatology and venereology (2024)
    3. [3]
      General practitioner prescription patterns for atopic eczema in children-Are they affected by telemedicine advice? — Ying G, Koch K The Australasian journal of dermatology (2024)
    4. [4]
      Diagnosis and Management of Pediatric Chronic Hand Eczema: The PeDRA CACHES Survey. — Haft MA, Park HH, Lee SS, Sprague JM, Paller AS, Cotton CH et al. Paediatric drugs (2023)
    5. [5]
      Dermatology Quality of Life Index scores in Bangladeshi patients with atopic eczema and their families in East London. — Tawfik SS, Thomas BR, Kelsell DP, Grigg J, O'Toole EA The British journal of dermatology (2023)
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      European guideline (EuroGuiDerm) on atopic eczema: part I - systemic therapy. — Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S et al. Journal of the European Academy of Dermatology and Venereology : JEADV (2022)
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      European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. — Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S et al. Journal of the European Academy of Dermatology and Venereology : JEADV (2022)
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      Phototherapy for atopic eczema. — Musters AH, Mashayekhi S, Harvey J, Axon E, Lax SJ, Flohr C et al. The Cochrane database of systematic reviews (2021)
    9. [9]
      Safety of topical corticosteroids in atopic eczema: an umbrella review. — Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM et al. BMJ open (2021)
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      Measuring atopic eczema symptoms in clinical practice: The first consensus statement from the Harmonising Outcome Measures for Eczema in clinical practice initiative. — Leshem YA, Chalmers JR, Apfelbacher C, Furue M, Gerbens LAA, Prinsen CAC et al. Journal of the American Academy of Dermatology (2020)
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      Understanding economic evidence for the prevention and treatment of atopic eczema. — Sach TH, McManus E, Levell NJ The British journal of dermatology (2019)
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      Scoring of Hand Eczema: Good Reliability of Hand Eczema Extent Score (HEES). — Carlsson A, Svensson Å, Anderson CD, Baranovskaya I, Hindsén-Stenström M, Holt I et al. Acta dermato-venereologica (2017)
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      The Harmonizing Outcome Measures for Eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology. — Schmitt J, Apfelbacher C, Spuls PI, Thomas KS, Simpson EL, Furue M et al. The Journal of investigative dermatology (2015)
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      Topical therapy of hand eczema - analysis of the prescription profile from dermatologists in private practice. — Soost S, Abdollahnia M, Kostev K, Worm M Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG (2012)
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      Effects of the introduction of the German "Praxisgebühr" on outpatient care and treatment of patients with atopic eczema. — Schmitt J, Kirch W, Meurer M Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG (2009)
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