Most children will catch chicken pox before they are 10 years old. It is a common and usually mild illness caused by a virus called Varicella zoster.
Chicken Pox Overview
Chicken pox is a highly infectious but usually mild, disease caused by the herpes group of viruses. The virus is spread either by direct contact with the rash or by droplets expelled into the air by coughing or sneezing.
Chicken pox occurs worldwide and is seen throughout the year in areas with temperate climate, peaking during the months of March through May. 90% of cases are seen in children aged 14 years and younger.
Chicken pox symptoms
Chicken pox is characterized by a red, itchy rash, which blisters and then crusts over within 2 weeks. A mild flu-like illness is usually present before the appearance of the rash, and may cause fever, body ache, headache, nausea and loss of appetite. (See detailed symptoms section).
Chicken pox complications
Complications from chicken pox are rare in children. The most common complication is bacterial infection which cn cause the spots to become more red and inflamed. Complication in adults and those with weakened immune system are more common and include pneumonia and liver inflammation.
Chicken pox treatment
No specific medical treatment is usually required for chicken pox. Painkillers can help to reduce pain and fever and antihistamines or calamine lotion may help relieve itching. Antiviral drugs may occasionally be prescribed for people who have a high risk of complications from chicken pox. These reduce the duration of the infection and minimize the risk of complications. (See detailed treatment section)
If your child has chicken pox they should stay away from school until the last blister has crusted over. He or she should also avoid contact with others who might be at a high risk of infection, such as newborn babies and people with a weak immune system.
Chicken Pox Tips
- Treatment for chickenpox is about relieving symptoms and stopping the child from scratching the spots to prevent the risk of infection.
- Calamine lotion or a cool bath with a few tablespoons of bicarbonate of soda can help reduce the itch. Keep your child cool to minimise the itch.
- Keep fingernails short or put cotton socks over their hands at night to prevent scratching. Children’s paracetamol may help reduce fever. Do not give aspirin to children with chickenpox
Chicken Pox Symptoms
The most noticeable symptom of chicken pox is the red itchy rash of fluid filled blisters.
Mild flu-like symptoms usually occur before the appearance of the rash, and may cause fever, body aches, headache, nausea and loss of appetite. These symptoms are generally more pronounced in adults than they are in children.
The rash usually appears on the stomach and back and then spreads to the face and arms and legs. The rash starts as small, itchy, red spots. Fluid filled blisters (dew drop) develop over the area of redness. This ‘dew drop on a rose petal’ lesion is typical of chicken pox. The blister breaks down in around 12-14 hours and crusts over within 1–4 days.
Chicken pox blisters are very contagious. The crust usually falls off within a week or two, sometimes leaving a crater-like scar. Another symptom of chicken pox is the fact that new skin blisters appear every day for several days.
The number of blisters in a person with chicken pox varies. Though usually ranging in number from 100 to 300, older children and adults are prone to develop significantly more lesions. Cases of chickenpox caught from household members are usually more severe than those developed from community contact.
People with conditions like sunburn or eczema may also suffer a more severe symptoms from chicken pox. Besides affecting the skin, blisters may also appear in the eyes, mouth, and vagina.
Remember that it is important to contact your doctor if you are pregnant or have a weakend immune system and have been in contact with someone that has chicken pox, even if you don't have any symptoms.
Chicken Pox Complications
Although chicken pox is generally a mild disease with uneventful recovery, a small number of people may develop complications. Newborns, people with weak immune systems, and adults form a high-risk group.
The most common complications are skin infections and pneumonia.
Other more serious complications include encephalitis (inflammation of the brain) and hepatitis. Reye’s syndrome is a serious complication that may be induced by treating chicken pox with aspirin.
Chicken pox may occasionally be problematic for pregnant women, causing stillbirths, birth defects, or infection of the newborn during childbirth.
Chicken Pox Causes
Chicken pox is caused by the Varicella zoster virus (VZV), which belongs to the herpes group of viruses. Being extremely contagious, exposure to the virus will result in chickenpox in more than 90% of unprotected individuals within a period of 10–21 days.
The virus spreads by both direct contact with fluid from broken chickenpox blisters and through respiratory droplets (dispersed into the air by coughing and sneezing). Chickenpox is most infective from 2 to 3 days before the rash appears until all the blisters have crusted over.
After infection, the virus remains dormant in the body throughout a person’s life. Although people cannot get chickenpox twice, the same virus may cause shingles, a viral infection of nerve roots. Rarely, contact with a patient who has shingles can result in chickenpox in a previously unexposed individual.
Chicken Pox Diagnosis
A diagnosis of chickenpox is made on the basis of the patient’s history, the appearence of the rash and physical findings. Laboratory tests may be occasionally needed. Blister fluid may need testing if your doctor is worried about secondary bacterial infection of the skin.
Additional tests may be required in some patients, as in the immunosuppressed, in case the diagnosis is unclear. These tests usually serve to identify the virus responsible for the patient’s symptoms and include virus culture, immunofluorescence assay and Polymerase Chain Reaction (PCR).
Chicken Pox Treatment
Most patients with chicken pox will recover completely without treatment. However, the following may help in relieving associated symptoms:
Early symptoms like fever and body ache may be treated with acetaminophen or ibuprofen, doses for children being determined by body weight. Aspirin should be completely avoided. Medical studies have demonstrated that children suffering from a viral illness like chicken pox when treated with aspirin may develop the potentially fatal condition known as Reye's syndrome.
Consult your GP or pharmacist if you are unclear about the medication that may be given to your child or during pregnancy.
Fluid replacement is important to prevent dehydration. Sugar-free ice-lollies may be used in children over the age of four. These help to lower temperature and soothe the mouth. Avoid hot and salty foods that may make your mouth sore.
Over the counter treatments like antihistamines may be used for the relief of severe itching. Some of these cause drowsiness and may help the patient sleep at night. Calamine lotion is commonly used for local application to reduce itching. Frequent baths may also help ease itching. Finely ground oatmeal or baking soda may be added to the bath water to soothe the skin.
Tepid sponging should be avoided in patients with chicken pox.
General hygiene measures will contribute to easing symptoms. Loose, smooth cotton clothing is advisable if the skin is itchy and sore. Keep your child’s fingernails clean and trimmed short to prevent deep scratching, as this increases the risk of secondary bacterial infection. Young children may need to have their hands covered with mittens/socks at night to prevent scratching during sleep.
Treatment with Acyclovir:
Acyclovir is an anti-viral drug that may be used to treat chickenpox. In uncomplicated cases Acyclovir taken 5 times a day has been shown to shorten the course of the disease if started within 24 to 48 hours of the onset of the rash. Oral Acyclovir is more strongly recommended in the high- risk group, as in children with underlying skin disease such as eczema, newborns, adults, and smokers. The drug is administered intravenously in people with compromised immune systems.
Treatment of complications:
Appropriate treatment for complicated cases will be decided by your doctor, generally in a hospital setting. Pneumonia and skin infections may be treated with antibiotics. Encephalitis is usually managed with antiviral drugs.
Chicken Pox Prevention
Keep your child away from school or nursery. Inform the child’s school of his health condition and let him or her return to school only once the blisters have fully crusted over. The patient is not considered infectious after this period. This usually takes about a week after appearance of the first blister.
It is best to avoid contact with those at high risk for infection.
If you or your child has chickenpox, it would be considered safe to travel by air only once all blisters have crusted over. Your travel plans will need to be modified accordingly.
The chickenpox virus can occasionally spread through indirect contact with infected objects like toys, bedding, or clothing. These will need to be washed regularly and surfaces cleaned with a disinfectant to prevent further spread of the virus.
As the disease generally runs a mild course, the chickenpox vaccine does not form part of the routine childhood vaccination programme in the UK. It is recommended by the Department of Health for non-immune healthcare workers or for persons at high risk, except during pregnancy.
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