How to manage a scar from a smallpox vaccine?

Management of Smallpox Vaccine Scar

The smallpox vaccine scar is a normal, expected outcome of successful vaccination and typically requires no treatment, as it represents evidence of appropriate immune response and "vaccine take." 1

Understanding the Normal Scar

• The smooth scar that forms at the vaccination site is the typical resolution pattern and is discussed during prevaccination counseling 2
• Scar formation is an established marker of successful vaccination for both smallpox and BCG vaccines 3
• The vaccination site progresses through predictable stages: papule formation (2-5 days), pustule development, scab formation, and finally scab separation (14-21 days), leaving a permanent scar 1

Routine Care During Healing (If Recently Vaccinated)

If the vaccination is recent and still healing, proper wound care focuses on preventing viral transmission rather than scar management:

• Keep the site dry, though normal bathing can continue 1
• The site can be left uncovered or loosely covered with porous gauze bandage until the scab separates naturally 1
• Do not apply salves or ointments to the vaccination site 1
• Avoid occlusive bandages as they cause maceration of the site 1
• Practice thorough hand hygiene with soap and water or >60% alcohol-based hand rubs after any contact with the site 1
• Dispose of contaminated bandages in sealed plastic bags 1

When to Seek Medical Evaluation

Contact CDC or your healthcare provider immediately if you develop:

• Extensive spreading lesions beyond the vaccination site (possible generalized vaccinia or eczema vaccinatum) 1
• Progressive, painless necrosis at the vaccination site (possible progressive vaccinia) 1
• Systemic illness with fever and widespread rash 1
• Eye involvement requiring ophthalmologic evaluation 1

CDC consultation is available at (404) 639-3670 during business hours or (404) 639-3311 evenings/weekends for suspected complications 1

Long-Term Scar Complications

• While the typical outcome is a smooth scar, other lesion types may develop at the scar site, including benign and malignant changes 2
• Keloid formation can occur, particularly in darker-skinned individuals with familial tendency, and may progress with additional vaccines given at the same site 4
• Keloid treatment is difficult but typically involves surgical excision, cryotherapy, radiation, and intralesional/topical corticosteroids 4
• Healthcare providers should consider periodic scar surveillance as part of general physical examination 2

Key Pitfalls to Avoid

• Never apply topical medications or ointments to an actively healing vaccination site as this deviates from established protocols 1
• Do not confuse normal vaccination site evolution with complications requiring intervention 1
• Avoid revaccination at sites with previous keloid formation in susceptible individuals 4
• Do not dismiss concerns about atypical scar changes during long-term follow-up 2