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Chickenpox

What is chickenpox?

Chickenpox (varicella) is a mild disease, but is highly contagious and in adults it may result in severe illness. It is caused by a virus that can also cause shingles (herpes zoster). Recovery occurs naturally, because a virus cannot be killed by drugs. Chickenpox affects mainly children under the age of 10.

What are the symptoms?

General

Children are not very sick, but are usually lethargic and have a mild fever. Adults have an influenza-like illness

The rash

The pocks come out in crops over 3 days. At first they resemble red pimples, but in a few hours these form blisters that look like drops of water. The blisters are very fragile and soon burst to leave open sores, which then form a scab and become dry. They can be very itchy.

The site of the rash

The pocks are concentrated on the trunk and head, but spread to the limbs. Do not be alarmed if they appear in or on the mouth, eyes, nose, scalp, vagina or penis.

How infectious is chickenpox?

The disease is very infectious and can spread by droplets from the nose and mouth or by direct contact with the 'raw' pocks. Patients are infectious for 24 hours before the pocks erupt and remain so until all the pocks are covered by scabs and no new ones appear. The incubation period is about 12 days, and so the disease appears about 2 weeks after exposure to an infected person. After recovery, lifelong immunity can be expected.

What are the risks?

It is usually a mild illness with complete recovery, but rarely encephalitis and pneumonia occur. Infection of the spots can occur. A severe reaction occurs rarely if aspirin is used in children.

Scarring

Most people worry about this, but usually the spots do not scar unless they become infected.

Exclusion from school

Children should be kept at home for 7 days or until all the pocks are dried and covered by scabs. At home it would be sensible to expose other children to the infected person so that the illness can be contracted before adulthood.

What is the treatment?

• The patient should rest in bed until feeling well.
• Give paracetamol for the fever. (Avoid aspirin.)
• Daub calamine or a similar soothing lotion to relieve itching, although the itch is usually not severe.
• Avoid scratching; clean and cut fingernails of children.
• Keep the diet simple. Drink ample fluids, including orange juice and lemonade.
• Daily bathing is advisable, with sodium bicarbonate added (half a cup to the bath water) or with ordinary soap. Pat dry with a clean, soft towel; do not rub.

  Copyright 1995: John Murtagh, Professor of General Practice
  Monash University, Melbourne, Australia