Varicella rash tends to have a central distribution with lesions first appearing on the head, then trunk, and finally the extremities, evolving through stages of macules, papules, vesicles, pustules, and crusts. The rash is characterized by rapid evolution of lesions during the initial 8 to 12 hours and by successive crops of new lesions and by the presence of lesions in different stages of development at the same time. New vesicle formation continues for 2 to 4 days, accompanied by pruritus, fever, headache, malaise, and anorexia. 7 Primary varicella can cause substantial morbidity in HIV-seropositive adolescents and adults. Visceral dissemination, especially VZV pneumonitis, is well documented. 7 Because most HIV-infected adults in the United States are VZV seropositive, primary varicella is an uncommon occurrence in this population.
Biswas 2003 was a multicentre, randomised trial of 253 infants of less than 30 weeks' gestational age. The infants were mechanically ventilated and were entered within nine hours of birth. All were given surfactant in the first 24 hours of life. Those in the treatment group (n = 125) were randomised to receive an infusion of hydrocortisone of 1 mg/kg/day and tri-iodothyronine (T3) of 6 µg/kg/day for five days, then hydrocortisone mg/kg/day and T3 3 µg/kg/day for two days. The placebo group (n = 128) received an equal volume of 5% dextrose.