Atypical chicken pox infection

Selma El Kadiri, Hanane Bay Bay, Rhizlane Chaoui, Zakia Douhi, Sara Elloudi, Fatima Zahra Mernissi

Department of Dermatology, CHU Hassan II, Fez, Morocco

Corresponding author: Dr. Selma El Kadiri

Submission: 06.03.2020; Acceptance: 05.04.2020

DOI: 10.7241/ourd.2020e.39

Cite this article: El Kadiri S, Bay Bay H, Chaoui R, Douhi Z, Elloudi S, Mernissi FZ. Atypical chicken pox infection. Our Dermatol Online. 2020;11(e):e39.1-e39.2.

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Chickenpox infection is a viral benign and very contagious infection in children, caused by the varicella-zoster virus. Eruption appears first on the scalp and face, then spreads to the trunk and, later, to the extremities with respect for the palms and soles [1].

We report a case of chickenpox reaching in a child with a perineal papular-vesicular rash.

We report a case of 3-years -old girl who presented umbilicated papulo-vesicles surrounded by an erythematous border on the vulva and buttocks and evolving for 24 hours without associated fever (Figs. 1a and 1b) compatible with the diagnosis of Chikenpox. After forty-eight hours, a vesicular exanthema of classical varicella distribution appeared. The follow-up was favorable in two weeks.

Figures 1: (a and b) Papulo-vesiuclar eruption in vulva and perianal area.                  


We report a case of an acute perineal pruriginous papular-vesicular rash corresponding to the mode of onset of chickenpox. Only one case of chickenpox with a perineal onset has been cited in the literature by Fischer and al. in their series of 130 cases of vulvar pathologies in prepubertal girls [2]. Recently 3 cases of perineal chickenpox were reported in France [3]. In one hand, we can explain this mode of perineal beginning by a a Koebner phenomenon induced by the layers exacerbated by, maceration. In an other hand, this mode of onset can be explained by the fact that these patients are a rarely seen at a very early stage or by absence of systematic examination of genial area [3]. This atypical localization can be misdiagnosed as Hand- Foot-and-Mouth disease.

Acute perineal papular-vesicular lesions should suggest chickenpox at an early stage.


The examination of the patient was conducted according to the Declaration of Helsinki principles.

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


1. CEDEF:Infections àherpès virus de l’enfant et de l’adulte immunocompétents:varicelle et zona. Ann Dermatol Venereol. 2012;139:A22-8.

2. Fischer G, Rogers M. Vulvar disease in children:a clinical audit of 130 cases. Pediatr Dermatol. 2000;17:1-6.

3. Bekkali N. Varicelle débutant par des lésions périnéales:3 cas. Ann Dermatol Vénéréol. 2020;147:52-4.


Source of Support: Nil.

Conflict of Interest: None declared.

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