Unmasking the Pox: Clinical Spectrum and Complications of Adult Varicella in a District Hospital

Background: Adult varicella presents with increased severity and complications compared to pediatric cases, yet it remains understudied in low-vaccination regions. This study characterizes the clinical profile and complications of adult varicella in South India. Materials and Methods: A cross-sectional study was conducted among 60 adults (≥18 years) with clinically diagnosed varicella presenting to a district hospital dermatology department from December 2022 to August 2023. Demographic, clinical, and epidemiological data were systematically collected and analyzed. Results: The cohort comprised 32 males (53.3%) and 28 females (46.7%), with median age of 25 years (range 18–55 years). Peak incidence occurred in the 20–29 years age group ( n = 34, 56.6%) and during March ( n = 22, 36.6%). Primary infections predominated ( n = 52, 86.6%). Common presentations included fever ( n = 51, 85%), pruritic vesicles ( n = 57, 95%), and mucosal involvement ( n = 40, 66.6%). Comorbidities were present in 25% of patients, with diabetes mellitus and depression being most frequent (10% each, n = 6). Complications developed in 21.5% ( n = 13) of cases, including secondary bacterial infections ( n = 6, 10.4%), pharyngotonsillitis ( n = 4, 6.1%), and varicella pneumonia ( n = 3, 5%). Only 15% ( n = 9) had received varicella vaccination; notably, no vaccinated patients developed complications. Conclusion: Adult varicella demonstrates significant morbidity with frequent complications, particularly in unvaccinated individuals. These findings support enhanced adult immunization strategies and improved surveillance in regions with suboptimal vaccination coverage.