Chickenpox is a common childhood skin disease caused by a virus. The virus is called the varicella-zoster virus.
Most people contract chickenpox by age 15, the majority between ages 5 and 9, but all ages can contract it. Chickenpox is usually more severe in adults and very young infants than children. Winter and spring are the most common times of the year for chickenpox to occur.
How does chickenpox spread?
Chickenpox is very highly contagious. It is easily passed between members of families and school classmates through airborne particles, droplets in exhaled air and fluid from the blisters or sores. It also can be transmitted indirectly by contact with articles of clothing and other items exposed to fresh drainage from open sores. Patients are contagious up to five days (more commonly, one to two days) before and five days after the date that their rash appears. When the sores have crusted over, the person is usually no longer contagious.
What are the signs and symptoms of chickenpox?
Symptoms tend to appear 14 to 16 days after the initial exposure but can occur any time from 10 days up to 21 days after contact with the virus. Chickenpox is characterized by one to two days of mild fever up to 102 degrees F, general weakness, and a rash, often the first sign of the disease. Rarely, a person may have the disease without the rash. The rash of chickenpox develops in crops with raised red spots arriving first, progressing to blisters that burst, creating open sores, before crusting over. This process usually starts on the scalp, then the trunk (its area of greatest concentration), and finally the arms and legs. Any area of skin that is irritated (by diaper rash, poison ivy, eczema, sunburn, etc.) is likely to be hard hit by the rash. The rash is typically very itchy (pruritic).
What are the treatments for chickenpox?
Most of the treatments for chickenpox are aimed at decreasing the symptoms, such as severe itching. Acetaminophen (Tylenol) can be used to decrease the fevers and aches often associated with the initial presentation of the viral infection. Children should never be given aspirin or aspirin-containing cold medications because of the risks for developing Reye's syndrome (a severe acquired metabolic disease associated with liver and brain dysfunction and death).
Frequent oatmeal baths (Aveeno, etc.) can decrease the itching associated with chickenpox. In addition, soothing lotions and moisturizers such as calamine lotion or any other similar over-the-counter preparation can be applied to the rash.
Benadryl or other antihistamines can be helpful in controlling the itching. Though Benadryl is available over the counter, other antihistamines can also be used. Always discuss these treatment options with your health-care practitioner.
In addition to medications, there are also preventive measures that are needed. For young children, it is important to keep nails trimmed in order to minimize injury due to scratching and to control the risks for secondary bacterial infections.
Lastly, in some cases of chickenpox, acyclovir can be prescribed. Acyclovir is an antiviral medication which has been used to shorten the duration of the infection. This medication has only been shown to be affective if started within one to two days of onset of the rash associated with chickenpox. Most commonly, this treatment is reserved for patients with other diagnoses which put them at risk for severe disease (severe skin diseases, immunodeficiency).
What are the possible complications of chickenpox?
Complications can and do occur from chickenpox. Infection of the open pox sore by bacteria can injure the skin, sometimes causing scarring, especially if the patient scratches the inflamed area. Bacterial skin infection is, in fact, the most common complication of chickenpox in children. The next most common complications in children affect the central nervous system and include a disorder of the cerebellar portion of the brain (cerebellar ataxia with wobbliness, dizziness, tremor, and altered speech), encephalitis (inflammation of the brain with headaches, seizures, and decreased consciousness), damaged nerves (nerve palsies) and Reye's syndrome, a potentially fatal combination of liver and brain disease that can be associated with aspirin. (Children with fever should not take aspirin.) Especially serious
complications can occur in patients with AIDS, lupus, leukemia, and cancer. Complications also occur in people taking immune-suppressing drugs, such as cortisone-related medications. Newborn infants whose mothers have chickenpox in the last trimester of pregnancy are at increased risk from the disease. If the mother develops the disease from five days before to two days after delivery, the fatality rate for the baby is up to 30%.
Can chickenpox be prevented with a vaccine?
Most people develop lifetime immunity to chickenpox after the first occurrence and never experience it again. But the virus can sometimes resurface later in life as shingles (zoster). The current aim in the U.S. and many other countries is to achieve universal (or nearly universal) immunization of children with the chickenpox vaccine. The vaccination requires only two shots. The first vaccination is given at about 1 year of age, and the second (booster) is given at 4 years of age. If an older person has not had chickenpox, the shot may be given at any time. There have been few significant adverse reactions to the chickenpox vaccine. All children, except those with a compromised immune system, should have the vaccination.
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