Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination. It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin in people with previous diagnosed skin conditions such as eczema or atopic dermatitis, even if the conditions are not active at the time. Other signs and symptoms include fever and facial and supraglottic edema. The condition may be fatal if severe and left untreated. Survivors are likely to have some scarring (pockmarks). Smallpox vaccine should not be given to patients with a history of eczema. Because of the danger of transmission of vaccinia, it also should not be given to people in close contact with anyone who has active eczema and who has not been vaccinated. People with other skin diseases (such as atopic dermatitis, burns, impetigo, or herpes zoster) also have an increased risk of contracting eczema vaccinatum and should not be vaccinated against smallpox. Presentation
Associations
Eczema is also associated with increased complications related to other vesiculating viruses such as chickenpox; this is called eczema herpeticum. Diagnosis
A culture of vesicular fluid will grow vaccinia virus. Skin biopsy shows necrotic epidermal cells with intranuclear inclusions. Treatment
Eczema vaccinatum is a serious medical condition that requires immediate and intensive medical care. Therapy has been  supportive, such as antibiotics, fluid replacement, antipyretics and analgesics, skin healing, etc. ; vaccinia immune globulin (VIG) could be very useful but supplies may be deficient as of 2006.
Eisai also markets Zonegran in Asia (China, Taiwan, and fourteen others) and Europe (starting in Germany and the United Kingdom). Research
Tardive dyskinesia
In an open-label trial zonisamide attenuated the symptoms of tardive dyskinesia. Obesity
It has also been studied for obesity with significant positive effects on body weight loss and there are three ongoing clinical trials for this indication. It was to be sold, when combined with bupropion, under the brand name Empatic, until its development was discontinued. Migraine
Zonisamide has been studied for and used as a migraine preventative medication, when topiramate is either ineffective or cannot be continued due to side effects. Bipolar depression
It has also been used off-label by psychiatrists as a mood stabilizer to treat bipolar depression. References
External links
"Zonisamide". Drug Information Portal. U.S. National Library of Medicine.