Overview

Varicella, more commonly known as chickenpox, is a very contagious infection caused by the varicella-zoster virus (VZV). It mainly affects children, but adults can get it too. The most well-known symptom is a super itchy rash with fluid-filled blisters. For most healthy children, chickenpox is a mild illness that goes away on its own. However, it can be more serious in adults, babies, and people with weakened immune systems.

The virus spreads easily from person to person through the air when an infected person coughs or sneezes. It can also be spread by touching the fluid from chickenpox blisters. Someone with chickenpox can spread the virus even before they have any signs of being sick. It is not an inherited condition. While it is usually a once-in-a-lifetime illness, the virus stays in your body and can come back years later as a painful rash called shingles.

Living with the constant itch of chickenpox can be tough, especially for little ones. It can disrupt sleep and make for a very grumpy week. Thankfully, the chickenpox vaccine has made this infection much less common than it used to be.

Symptoms

The most classic sign of chickenpox is a rash that turns into itchy, fluid-filled blisters. Here’s what you can typically expect:

• A Rash That Changes: It starts as small red spots that can appear anywhere on the body, including inside the mouth, on the scalp, and around the genital area. These spots quickly turn into fragile, thin-walled blisters filled with clear fluid.
• Intense Itching: The rash is famously itchy. It can be very uncomfortable and make it hard to sleep. We know how hard it is to tell your child not to scratch, but it’s important to prevent scarring and infection.
• Fever: A mild to moderate fever, usually between 101°F and 102°F (38.3°C to 38.9°C), often comes just before or with the rash.
• Feeling Unwell: You or your child might feel tired, lose your appetite, and have a general sense of being unwell (malaise) a day or two before the rash appears.
• Headache and Sore Throat: A mild headache and a sore throat can also be early symptoms of chickenpox.
• Crusting and Scabbing: After about 24 to 48 hours, the blisters will cloud over and then crust over to form scabs. New waves of blisters can appear for several days, so you might see spots, blisters, and scabs all at the same time.
• Swollen Lymph Nodes: You may notice tender, swollen glands, particularly in the neck.

Diagnosis

Diagnosing chickenpox is usually straightforward. A doctor or healthcare provider can often tell if it's chickenpox just by looking at the tell-tale rash. The distinct appearance of red spots, blisters, and scabs all at once is a key giveaway.

In some cases, especially if the rash doesn't look typical or if there's a need to be absolutely sure, your doctor might do a lab test. This involves taking a small sample of fluid from a blister or a scraping from a scab and sending it to a lab to check for the varicella-zoster virus. Blood tests can also be done to see if you have antibodies to the virus, which would show if you're immune from a past infection or a vaccine.

For most healthy kids, a trip to the doctor might not even be needed if the symptoms are mild and you're sure it's chickenpox. However, it's always best to call your doctor for advice, especially if you're unsure or if the person with the rash is an infant, an adult, pregnant, or has a weakened immune system.

Management & Treatment

Seeing your child covered in itchy spots can be distressing, but rest assured, for most healthy kids, chickenpox is a manageable illness that clears up on its own. The main goal of treatment is to relieve the symptoms and keep your child comfortable while their body fights off the virus.

In many cases, chickenpox simply needs to run its course. Here’s how you can help manage the symptoms at home:

• Over-the-Counter (OTC) Options:
  • For Itching: Calamine lotion can be very soothing for itchy skin. You can also find other topical anti-itch creams or gels, like those containing pramoxine. Cool compresses or lukewarm baths with added colloidal oatmeal or baking soda can also provide significant relief.
  • For Fever: You can use acetaminophen (like Tylenol) to help bring down a fever and ease any aches. Important Warning: Never give aspirin to a child with chickenpox. This has been linked to a serious condition called Reye's syndrome, which can affect the liver and brain. It's also best to avoid ibuprofen, as it has been associated with a higher risk of severe bacterial skin infections.
• Home Care and Self-Management:
  • Don't Scratch! We know it's hard, but scratching can lead to bacterial infections and scarring. Keep your child's fingernails trimmed short and consider having them wear mittens or socks on their hands, especially at night.
  • Stay Hydrated: Encourage plenty of fluids like water, Pedialyte, or diluted fruit juices to prevent dehydration, especially if there's a fever.
  • Rest Up: Like with any viral infection, rest is key to helping the body recover.
• When Prescription Treatments May Be Needed:
  • For some people, a doctor may prescribe an antiviral medication like acyclovir or valacyclovir. These work best when started within the first 24 to 48 hours after the rash appears. They don't cure chickenpox but can make the illness less severe and shorten its duration.
  • Antiviral medication is usually recommended for people at higher risk for complications, including:
    • Healthy people over the age of 12
    • Anyone with a weakened immune system (immunocompromised)
    • People with chronic skin conditions (like eczema) or lung conditions (like asthma)
    • Infants and pregnant women
• Expected Timeline for Improvement:
  • The worst of the symptoms, including the fever and the appearance of new blisters, usually lasts for a few days. The blisters will typically start to scab over within a week, and most scabs will fall off within one to two weeks.
• What to do if treatments aren't working:
  • If the itching is unbearable despite home remedies, or if the fever is very high or lasts for more than four days, it's time to call your doctor. Also, watch for signs of complications like a skin infection (redness, swelling, or pus), difficulty breathing, a stiff neck, or if you or your child seems confused or is hard to wake up. Trust your instincts – if you're worried, it's always best to seek medical advice.

Duration & Outlook

The good news is that for most healthy children, chickenpox is a short-lived, or acute, illness. The entire process, from the first symptom to the last scab falling off, usually takes about one to two weeks. The most uncomfortable part, with the fever and the constant arrival of new itchy spots, typically lasts for about four to seven days. After the fifth day, you'll likely see new blisters starting to slow down.

Once you've had chickenpox, you usually have immunity for life, meaning you won't get it again. However, the varicella-zoster virus doesn't completely leave your body. It stays dormant in your nerve cells and can reactivate later in life, causing a different condition called shingles, which is a painful, blistering rash.

For most people, the outcome of a chickenpox infection is excellent, with a full recovery and no lasting effects other than immunity. It's important to be aware of potential warning signs for complications. These can include a very high fever, a rash that gets very red, warm, or tender (which could signal a bacterial skin infection), difficulty breathing, a severe cough, a stiff neck, confusion, or difficulty walking. These are rare but serious, so if you notice any of them, it's crucial to see a doctor right away.

Prevention

The best way to prevent chickenpox is to get the varicella vaccine. The vaccine is safe and very effective at protecting against the virus. The Centers for Disease Control and Prevention (CDC) recommends two doses of the chickenpox vaccine for children, adolescents, and adults who have never had chickenpox and were never vaccinated.

For children, the first dose is typically given between 12 and 15 months of age, and the second dose is given between 4 and 6 years old. Getting both doses provides the best protection. While it's still possible to get chickenpox after being vaccinated, the illness is usually much milder with fewer blisters and a lower fever.

Avoiding close contact with someone who has chickenpox is also key to prevention. The virus is highly contagious and spreads through the air, so if someone in your household has it, it can be tricky to avoid. If you or your child has chickenpox, it's important to stay home from school, daycare, and work until all the blisters have scabbed over to prevent spreading it to others. This is especially important to protect vulnerable people like newborns, pregnant women, and those with weakened immune systems.

Causes & Triggers

Chickenpox is caused by a highly contagious virus called the varicella-zoster virus (VZV). It's not caused by anything you've done or not done – it's simply a matter of being exposed to the virus if you're not immune.

The virus spreads from person to person with ease. Here are the main ways it's transmitted:

• Through the Air: When a person with chickenpox coughs or sneezes, they release tiny droplets containing the virus into the air, which can then be breathed in by others.
• Direct Contact: You can also get chickenpox by touching the fluid from the blisters of an infected person.

Anyone who has not had chickenpox or has not been vaccinated is at risk of getting it. It is most common in children under the age of 12, but it can affect people of any age. Those most likely to develop chickenpox are individuals who have not been vaccinated and have close contact with an infected person, such as in a household, school, or daycare setting.

The main risk factor for getting chickenpox is a lack of immunity, either from a previous infection or from the vaccine. People with weakened immune systems, such as those undergoing chemotherapy or who have HIV, are not only at a higher risk of catching the virus but also of developing serious complications from it.

When to see a doctor:

While many cases of chickenpox in children can be safely managed at home, there are definitely times when you should call a doctor. It's always better to be cautious, especially when it comes to your health or your child's health.

Here are some signs to look for that should prompt you to seek medical advice:

• If you're unsure if it's chickenpox: A proper diagnosis ensures you're treating the right condition.
• If the person with the rash is in a high-risk group: This includes infants (especially newborns), adults, pregnant women, or anyone with a weakened immune system (due to conditions like cancer or HIV, or from taking certain medications).
• If the fever is very high (over 102°F or 38.9°C) or lasts longer than four days.
• If there are signs of a bacterial skin infection: Look for areas of the rash that are very red, swollen, warm to the touch, or are leaking pus.
• If you or your child seems very ill, is difficult to wake up, seems confused, is complaining of a stiff neck, is having trouble breathing, or has a severe cough. These could be signs of more serious complications like encephalitis (inflammation of the brain) or pneumonia.
• If you have chickenpox and are pregnant: It's important to talk to your doctor right away, as there can be risks to both you and your baby.

If you're ever in doubt, don't hesitate to contact your primary care doctor or a dermatologist. They can provide guidance, confirm the diagnosis, and recommend the best course of action to ensure a safe and speedy recovery.

Frequently Asked Questions (FAQs):

Q: How long is someone with chickenpox contagious? A: A person with chickenpox can spread the virus for 1 to 2 days before the rash appears and until all of the blisters have formed scabs. This usually takes about 5 to 7 days from when the rash first started.

Q: Can my child go to school with chickenpox? A: No, to prevent spreading the virus to others, your child should stay home from school or daycare until all the blisters have crusted over.

Q: If my child has been vaccinated, can they still get chickenpox? A: Yes, it is possible for a vaccinated person to get chickenpox. This is called a "breakthrough" infection. The good news is that the illness is almost always much milder, with fewer spots and a lower fever.

Q: Can I get chickenpox from someone with shingles? A: You can't get shingles from someone with shingles. However, if you have never had chickenpox or the vaccine, you can get chickenpox from direct contact with the fluid from shingles blisters.

Q: Is it safe to be around a pregnant woman if my child has chickenpox? A: It's very important to keep someone with chickenpox away from pregnant women who are not immune to the virus. Chickenpox during pregnancy can cause complications for both the mother and the baby.

Q: Does scratching the blisters really cause scars? A: Yes, scratching can break the skin and allow bacteria to get in, which can lead to an infection and permanent scars. Keeping those fingernails short and trying soothing remedies for the itch can make a big difference.

References

• Centers for Disease Control and Prevention. (2021, July 28). Chickenpox (Varicella). Retrieved from https://www.cdc.gov/chickenpox/index.html
• American Academy of Dermatology Association. (n.d.). Chickenpox: Diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/a-z/chicken-pox-treatment
• Mayo Clinic. (2022, October 27). Chickenpox. Retrieved from https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282