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Chickenpox

Overview

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face and then spreads over the entire body, causing multiple itchy blisters. Over several days, the blisters pop and start to leak. Then they crust and scab over before finally healing.

Etiology

Varicella-zoster virus (VZV) causes the chickenpox infection. Most cases occur through contact with an infected person. The virus is contagious to those around you for one to two days before your blisters appear. VZV remains contagious until all blisters have crusted over. The virus can spread through:

  • Saliva
  • Coughing
  • Sneezing
  • Contact with fluid from the blisters.

Signs and symptoms

An itchy rash is the most common symptom of chickenpox. The infection will have to be in your body for around 7 to 21 days before the inflammation and other symptoms develop. You start to be contagious to those around you up to 48 hours before the skin rash occurs.

The non-rash symptoms may last a few days and include:

  • Fever
  • Headache
  • Loss of appetite

One or two days after you experience these symptoms, the classic rash will begin to develop. The inflammation goes through three phases before you recover. These include:

  • You develop red or pink bumps all over your body.
  • The nodes become blisters filled with fluid that leaks.
  • The nodes become crusty, scab over, and begin to heal.
  • The bumps on your body will not all be in the same phase at the same time. New spots will continuously appear throughout your infection. The rash may be very itchy, especially before it scabs over with a crust.
  • You are still contagious until all the blisters on your body have scabbed over. The crusty scarred areas eventually fall off. It takes seven to 14 days to disappear completely.

Risk factors

Exposure to the virus through previous active infection or vaccination reduces risk. Immunity from the virus can be passed on from a mother to her newborn. Immunity lasts about three months from birth.

Anyone who has not been exposed may contract the virus. Risk increases under any of these conditions:

  • You have had recent contact with an infected person.
  • You are under 12 years of age.
  • You are an adult living with children.
  • You have spent time in a school or child care facility.
  • Your immune system is compromised due to illness or medications.

Diagnosis

Chickenpox is diagnosed based on a physical exam of blisters on you or your child’s body. Or, lab tests can confirm the cause of the blisters, such as blood tests or culture tests.

A blood test can be done to see if you have an active chickenpox infection or are immune to the disease. A small amount of blood is drawn and sent to a lab to check for varicella-zoster virus antibodies. The varicella-zoster virus is the virus that causes chickenpox. Sometimes a viral culture is done instead of a blood test.

Differential diagnosis

Chickenpox must be differentiated from other diseases presenting diffuse papulovesicular rash in a febrile patient. The various conditions that should be distinguished from chickenpox include:

  • Coxsackievirus
  • Stevens-Johnson syndrome
  • Kawasaki disease
  • Measles
  • Syphilis
  • Rubella
  • Cytomegalovirus
  • Meningococcemia 
  • Meningitis  
  • Rocky Mountain spotted fever      
  • Molluscum contagiosum   
  • Mononucleosis

Complications

Emergency Complications include:

  • The rash spreads to your eyes.
  • The rash is very red, tender, and warm (signs of secondary bacterial infection).
  • The rash is accompanied by dizziness or shortness of breath.

When complications occur, they most often affect:

  • Infants
  • Older adults
  • People with weak immune systems
  • Pregnant women
  • These groups may also contract VZV pneumonia or bacterial infections of the skin, joints, or bones.

Women exposed during pregnancy may bear children with congenital disabilities, including:

  • Poor growth
  • Small head size
  • Eye problems
  • Intellectual disabilities

Treatment

Most people diagnosed with chickenpox will be advised to manage their symptoms while waiting for the virus to pass through their system. Parents will be told to keep children out of school and daycare to prevent the spread of the virus. Infected adults will also need to stay home.

Your doctor may prescribe antihistamine medications or topical ointments, or you may purchase these over the counter to help relieve itching. You can also soothe itching skin by taking lukewarm baths, applying unscented lotion, wearing lightweight and soft clothing.

Heat and sweat make you itch more. Use a cool, wet washcloth on super-itchy areas to calm your skin.

Drink lots of fluids to help your body rid itself of the virus faster. It’ll also keep you from getting dehydrated.

Medications

Use Acetaminophen (Tylenol) for Pain and Fever

If you or your child has a high fever or achiness caused by chickenpox, reach for the Tylenol. It can even help relieve pain associated with sores that develop on your skin or in your mouth. It’s safe for most people, including pregnant women and children over two months old.

Avoid anti-inflammatory painkillers like ibuprofen. If you have chickenpox, it can make you very ill. Never give aspirin to children under age 16. It can lead to a severe complication called Reye’s syndrome.

Don’t Scratch That Itch

Yes, it’s tempting. But scratching your rash can put you at risk for a bacterial skin infection. It could also cause scarring. Try these tips to calm your itchy skin:

  • Tap or pat -- don’t scratch -- your itch
  • Take a cool oatmeal bath (you can buy it at your local drugstore). Dab or pat (don’t rub) your skin dry.
  • Wear loose, cotton clothing so your skin can breathe
  • Dab calamine lotion on your itchy spots
  • Try an antihistamine, like Benadryl, to ease your symptoms

Dietary Modification

Foods to Eat

  • Banana, rice, apple, and toast
  • Broken wheat
  • Carrot, sweet potato, beans, potato, and cabbage

Foods to Avoid

  • Milk, ice cream, butter, and cheese
  • Fried food
  • Salty food
  • Junk food

Prevention

The Chickenpox vaccine prevents chickenpox in 98 percent of people who receive the two recommended doses. Your child should get the shot between 12 and 15 months of age. Children get a booster between 4 and 6 years of age.

Older children and adults who haven’t been vaccinated or exposed may receive catch-up doses of the vaccine. As chickenpox tends to be more severe in older adults, people who haven’t been vaccinated may opt to get the shots later.

People unable to receive the vaccine can avoid the virus by limiting contact with infected people.

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