CHICKENPOX (Varicella)

General Information

DEFINITION--A very contagious, mild disease caused by the herpes zoster virus.

BODY PARTS INVOLVED--Skin and mucous membranes.

SEX OR AGE MOST AFFECTED--All ages, but most common in children.

SIGNS & SYMPTOMS--

The following are usually mild in children, severe in adults:

• Fever.
• Abdominal pain or a general ill feeling that lasts 1 or 2 days.
• Skin eruptions that appear almost anywhere on the body, including the scalp, penis and inside the mouth, nose, throat or vagina. They may be scattered over large areas, and they occur least on the arms and legs. Blisters collapse within 24 hours and form scabs. New crops of blisters erupt every 3 to 4 days.
• Adults have additional symptoms that resemble influenza.

CAUSES--Infection with the herpes zoster virus. It is spread from person to person by airborne droplets or contact with a skin eruption on an infected person. Incubation after exposure is 7 to 21 days. A newborn is protected for several months from chickenpox if the mother had the disease prior to or during pregnancy. The immunity diminishes in 4 to 12 months.

RISK INCREASES WITH

• Use of immunosuppressive drugs.
• Contact with an infected person (day care, school).

HOW TO PREVENT--Cannot be prevented at present. An immune globulin is available for high-risk persons, such as those who take anticancer or immunosuppressive drugs. Live attenuated (weakened) vaccines should be available soon.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor (the observance of the skin eruptions is usually sufficient for diagnosis).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's diagnosis and treatment, if complications arise.

POSSIBLE COMPLICATIONS

• Secondary bacterial infection of chickenpox blisters.
• Pneumonia.
• Viral eye infection.
• Encephalitis (rare).
• Reye's syndrome.
• Scarring, if blisters become infected (rare).
• Myocarditis.
• Arthritis (transient).

PROBABLE OUTCOME--

• Spontaneous recovery. Children usually recover in 7 to 10 days. Adults take longer and are more likely to develop complications.
• After recovery, a person has lifelong immunity against a recurrence of chickenpox.
• After chickenpox runs its course, the virus sometimes remains dormant in the body. The same virus may later cause shingles.

How To Treat

GENERAL MEASURES--

• Cool-water soaks (see Soaks in Appendix) or cool-water compresses to reduce itching.
• Keep the patient as quiet and cool as possible. Heat and sweat trigger itching.
• Keep the nails short to discourage scratching, which can lead to secondary infection. Have the child wear mittens if necessary.
• Notify parents of any children exposed to your child during the contagious period.

MEDICATION--

• The following non-prescription medicines may decrease itching: topical anesthetics and topical antihistamines, which provide quick, short-term relief. Preparations containing lidocaine and pramoxine are least likely to cause allergic skin reactions. Lotions that contain phenol, menthol and camphor (such as calamine lotion). Follow package instructions.
• If you must reduce fever, use acetaminophen. Never use aspirin in children under age 18 as it may contribute to the development of Reye's syndrome (a form of encephalitis) when given to children during a viral illness.

ACTIVITY--Bed rest is not necessary. Allow quiet activity in a cool environment. A child may play outdoors in the shade during nice weather. Keep an ill child away from others until all blisters have crusted.

DIET--No special diet.

Call Your Doctor If

• You or your child have symptoms of chickenpox.
• Lethargy, headache or sensitivity to bright light develop.
• Fever rises over 103F (39.4C).
• Chickenpox lesions contain pus or otherwise appear infected.
• A cough occurs during a chickenpox infection.