What Are the Symptoms and Treatment of Chickenpox?
Chickenpox appears as a very itchy rash that spreads from the torso to the neck, face, and limbs. Lasting seven to 10 days, the rash progresses from red bumps to fluid-filled blisters (vesicles) that drain and scab over. Vesicles may also appear in the mouth, on the scalp, around the eyes, or on the genitals and can be very painful.
The chickenpox rash goes through these three phases:
Who Gets Chicken Pox
Chickenpox is a disease of childhood - 90% of cases occur in children aged 14 years and younger. Before widespread vaccination, the incidence of chicken pox in the United States approached the annual birth rate, averaging between 3.1 and 3.8 million cases per year. Chicken pox can occur at any time, but occurs most often in March, April, and May in temperate climates.
When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can easily diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room.
Also, be sure to let your doctor know if any of these complications occur:
Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient. Children should never be given aspirin or medications containing aspirin for chicken pox or any other viral illness because of the risk of Reye's syndrome.
2. Chicken Pox Treatment - Soothing Baths
Frequent baths are sometimes helpful to relieve itching. Adding finely-ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water. One-half to one cup of baking soda may also be added to bath water to reduce itching.
3. Chicken Pox Treatment - Lotions
The most common lotion used for chicken pox is Calamine lotion. This or any similar over-the-counter preparation can be applied to the blisters to help dry them out and soothe the skin.
4. Chicken Pox Treatment - Antihistamines
Over-the-counter and prescription antihistamines may be used to control severe itching. Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sleep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness.
5. Chicken Pox Treatment - Preventing Scratching
Scratching increases the risk of secondary bacterial infections. All patients with chicken pox should have their nails trimmed short. In addition, small children may have to wear mittens to reduce scratching.
6. Chicken Pox Treatment - Acyclovir
Acyclovir (Zovirax) is an anti-viral drug that may be used to treat chicken pox. In uncomplicated cases acyclovir taken 5 times a day has been shown to cause shorter periods of new lesion formation, fewer lesions, and more rapid healing but only if started within 24 to 48 hours of the onset of the rash. Acyclovir has not been shown to decrease the rate of complications in otherwise healthy children who get chicken pox. Oral acyclovir is more strongly recommended for children with underlying skin disease such as eczema, newborns, adults, and smokers since this group is at greater risk for complications. IV acyclovir is used for people with compromised immune systems.
The most common complication of chickenpox is secondary bacterial infection of the chickenpox lesions. The bacteria most likely to cause infection are Staphylococcus aureus and Streptococcus pyogenes. The bacteria most commonly cause infections such as impetigo, furunculosis, cellulitis, erysipelas, and lymphadenitis. These infections are superficial, but there is a risk of the bacteria invading the bloodstream and causing bacteremia. People who develop bacteremia are at risk of developing bacterial pneumonia, meningitis, arthritis, osteomyelitis, sepsis, shock, and death. Chickenpox lesions that are secondarily infected should be treated with antibiotics.
Neurologic Complications
The second most common complication of chickenpox involves the neurological system. One of these disorders is called acute cerebellar ataxia which causes progressive irritability, difficulty walking, difficulty with vision, and speech disturbances that persist for days or weeks but normally clear completely over time. Another neurologic complication is varicella meningoencephalitis which causes sudden but transient delirium, seizures, headache, sensitivity to light, and neck pain. These symptoms usually resolve after 24 to 72 hours.
Respiratory Complications
The leading cause of varicella-related morbidity and mortality in adults, pregnant women, and people with compromised immune systems is varicella pneumonia. Approximately 1 in 400 adults who develop chickenpox are hospitalized for varicella pneumonia. Varicella pneumonia is caused by the spread of the virus in the bloodstream to the lungs. Risk factors for developing this complication include:
What Are the Symptoms and Treatment of Chickenpox?
Chickenpox appears as a very itchy rash that spreads from the torso to the neck, face, and limbs. Lasting seven to 10 days, the rash progresses from red bumps to fluid-filled blisters (vesicles) that drain and scab over. Vesicles may also appear in the mouth, on the scalp, around the eyes, or on the genitals and can be very painful.
The chickenpox rash goes through these three phases:
- Raised pink or red bumps (papules), which break out in different spots over several days
- Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
- Crusts and scabs, which cover the broken blisters and take several more days to heal
Who Gets Chicken Pox
Chickenpox is a disease of childhood - 90% of cases occur in children aged 14 years and younger. Before widespread vaccination, the incidence of chicken pox in the United States approached the annual birth rate, averaging between 3.1 and 3.8 million cases per year. Chicken pox can occur at any time, but occurs most often in March, April, and May in temperate climates.
When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can easily diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room.
Also, be sure to let your doctor know if any of these complications occur:
- The rash spreads to one or both eyes.
- The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
- The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 103 F (39.4 C).
- Anyone in the household is immune deficient or younger than 6 months old.
Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient. Children should never be given aspirin or medications containing aspirin for chicken pox or any other viral illness because of the risk of Reye's syndrome.
2. Chicken Pox Treatment - Soothing Baths
Frequent baths are sometimes helpful to relieve itching. Adding finely-ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water. One-half to one cup of baking soda may also be added to bath water to reduce itching.
3. Chicken Pox Treatment - Lotions
The most common lotion used for chicken pox is Calamine lotion. This or any similar over-the-counter preparation can be applied to the blisters to help dry them out and soothe the skin.
4. Chicken Pox Treatment - Antihistamines
Over-the-counter and prescription antihistamines may be used to control severe itching. Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sleep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness.
5. Chicken Pox Treatment - Preventing Scratching
Scratching increases the risk of secondary bacterial infections. All patients with chicken pox should have their nails trimmed short. In addition, small children may have to wear mittens to reduce scratching.
6. Chicken Pox Treatment - Acyclovir
Acyclovir (Zovirax) is an anti-viral drug that may be used to treat chicken pox. In uncomplicated cases acyclovir taken 5 times a day has been shown to cause shorter periods of new lesion formation, fewer lesions, and more rapid healing but only if started within 24 to 48 hours of the onset of the rash. Acyclovir has not been shown to decrease the rate of complications in otherwise healthy children who get chicken pox. Oral acyclovir is more strongly recommended for children with underlying skin disease such as eczema, newborns, adults, and smokers since this group is at greater risk for complications. IV acyclovir is used for people with compromised immune systems.
Potentially Life-Threatening Complications of Chicken Pox
1. Shingles
After the varicella virus infects the skin, it is not completely eliminated from the body as most viruses are. Instead the virus travels up the nerves to important nerve branching points called ganglia deep in the body where it stays in an inactive, or latent, form. During this time the virus does not replicate. It stays in this latent form for varying amounts of time. Certain triggers may cause the virus to travel back down the nerve to the skin causing painful, burning blisters. This condition is known as shingles, or herpes zoster (although it is not caused by the herpes virus), or varicella zoster, or just zoster. Shingles occur in about 20% of people who have had chicken pox.
Bacterial InfectionAfter the varicella virus infects the skin, it is not completely eliminated from the body as most viruses are. Instead the virus travels up the nerves to important nerve branching points called ganglia deep in the body where it stays in an inactive, or latent, form. During this time the virus does not replicate. It stays in this latent form for varying amounts of time. Certain triggers may cause the virus to travel back down the nerve to the skin causing painful, burning blisters. This condition is known as shingles, or herpes zoster (although it is not caused by the herpes virus), or varicella zoster, or just zoster. Shingles occur in about 20% of people who have had chicken pox.
The most common complication of chickenpox is secondary bacterial infection of the chickenpox lesions. The bacteria most likely to cause infection are Staphylococcus aureus and Streptococcus pyogenes. The bacteria most commonly cause infections such as impetigo, furunculosis, cellulitis, erysipelas, and lymphadenitis. These infections are superficial, but there is a risk of the bacteria invading the bloodstream and causing bacteremia. People who develop bacteremia are at risk of developing bacterial pneumonia, meningitis, arthritis, osteomyelitis, sepsis, shock, and death. Chickenpox lesions that are secondarily infected should be treated with antibiotics.
Neurologic Complications
The second most common complication of chickenpox involves the neurological system. One of these disorders is called acute cerebellar ataxia which causes progressive irritability, difficulty walking, difficulty with vision, and speech disturbances that persist for days or weeks but normally clear completely over time. Another neurologic complication is varicella meningoencephalitis which causes sudden but transient delirium, seizures, headache, sensitivity to light, and neck pain. These symptoms usually resolve after 24 to 72 hours.
Respiratory Complications
The leading cause of varicella-related morbidity and mortality in adults, pregnant women, and people with compromised immune systems is varicella pneumonia. Approximately 1 in 400 adults who develop chickenpox are hospitalized for varicella pneumonia. Varicella pneumonia is caused by the spread of the virus in the bloodstream to the lungs. Risk factors for developing this complication include:
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