{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T14:59:27Z","timestamp":1766847567304,"version":"3.40.5"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,2,27]],"date-time":"2022-02-27T00:00:00Z","timestamp":1645920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>In previously healthy subjects, primary varicella presents with a distinctive vesicular rash that is more intense on the trunk and head than on the extremities. However, an atypical presentation may occasionally develop. We aimed at systematically assessing the characteristics of cases affected by atypical primary varicella rash.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The United States National Library of Medicine, Excerpta Medica and Web of Science databases were reviewed, without date or language restrictions. Articles were eligible if reporting previously healthy and immunocompetent subjects with a primary varicella rash (i.e., a photo\u2010localised primary varicella or skin inflammation\u2010associated primary varicella).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010eight reports providing information on 59 cases of atypical primary varicella were identified. Twenty\u2010four cases (median 8.5\u00a0years of age, 19 females) were photo\u2010localised and 35 (median 4.8\u00a0years of age, 15 females) were associated with pre\u2010existing skin inflammation (including cast occlusion, diaper irritation, operative sites, burns, insect bites, vaccinations or pre\u2010existing skin disease). The skin rash was monomorphic and without a \u201cstarry sky\u201d appearance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Primary varicella may have a modified presentation in areas of irritation such as sun exposure or pre\u2010existing inflammation. There is a need for a wider awareness of these modulators of varicella rash.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.16300","type":"journal-article","created":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T03:53:15Z","timestamp":1645156395000},"page":"935-939","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Atypical primary varicella rash: Systematic literature review"],"prefix":"10.1111","volume":"111","author":[{"given":"Calogero","family":"Mazzara","sequence":"first","affiliation":[{"name":"Pediatric Institute of Southern Switzerland Ospedale San Giovanni Ente Ospedaliero Cantonale  Bellinzona Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-4254","authenticated-orcid":false,"given":"Gregorio Paolo","family":"Milani","sequence":"additional","affiliation":[{"name":"Pediatric Unit Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico  Milan Italy"},{"name":"Department of Clinical Sciences and Community Health Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastiano A. 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