Clinical photograph comparison in a pediatric patient showing the evolution of a BCG (Bacillus Calmette-Guérin) vaccine inoculation site on the right deltoid. Figure A demonstrates a local adverse reaction characterized by an erythematous, indurated area with active purulent discharge emanating from a central pustule. This represents the acute inflammatory phase or a localized abscess. Figure B shows the same anatomical site two months later, following wound management. The inflammatory features—erythema and discharge—have completely resolved, replaced by a characteristic, small, hypopigmented atrophic scar. The images illustrate the progression from an active localized complication to a healed BCG scar, providing a visual reference for clinical monitoring of vaccination sites.

A clinical photograph comparison of two different types of local skin reactions (BCGitis) at the Bacille Calmette-Guerin (BCG) inoculation site on the upper arm of pediatric patients. Image (a) demonstrates erythema following the transdermal delivery method, characterized by a diffuse, irregular patch of redness on the deltoid region containing a grid-like pattern of multiple small, discrete erythematous papules corresponding to the multi-puncture device application. Image (b) shows the reaction following the intradermal delivery method, presenting as a localized, circular erythematous plaque with a solitary, central crusting papule or pustule, often described as a bullseye appearance. These visual manifestations are clinically significant as markers for Kawasaki disease (KD) when observed in febrile infants, representing a specific cutaneous finding known as BCG site reactivation. The image serves as an educational tool for distinguishing between normal and pathological vaccine site inflammation across different administration routes in pediatric dermatology and immunology.

This clinical photograph set illustrates the progression of a Bacillus Calmette-Guérin (BCG) vaccination site on an infant, demonstrating the transition from an immediate skin reaction to long-term scarring. Panel (a) shows a neonatal skin reaction immediately following intradermal injection. A characteristic raised, blanched papule or 'wheal' is visible, representing the dermal deposit of the vaccine. The diameter of this wheal is being objectively measured using a transparent millimeter ruler to assess the success of the administration. Panel (b) depicts the same anatomical region—the upper left arm—at 13 months of age. It shows a definitive BCG scar, which is characterized by a round, flat, and hypopigmented area relative to the surrounding tissue. Black arrows in both panels highlight the specific site of interest. This comparison serves as an educational tool for healthcare providers to understand the correlation between the initial vaccination wheal and the subsequent development of a permanent vaccine scar, which is often used as a clinical marker of vaccination history in tuberculosis prevention programs.