Chickenpox

Symptoms: Itchy rash, fever, tiredness, loss of appetite, headache

Causes: Varicella-zoster virus (VZV)

Risk Factors: Unvaccinated, weakened immune system, pregnancy

Severity: Mild to severe

Which doctor to consult: Paediatrician (in case of children), Dermatologist, Infectious disease specialist, Internal medicine specialist

Overview:

Chickenpox, also known as Varicella, is a highly contagious disease caused by varicella-zoster virus (VZV). It can strike anyone at any age but mostly affects children.

The common symptom of chickenpox is a rash which starts as raised pink or red bumps, progresses to fluid-filled blisters, and eventually forms crusts and scabs. It is spread through direct contact with the rash or the release of virus-containing air droplets from an infected person coughing or sneezing. 

If you haven’t had a vaccination or haven’t already had chickenpox, the risk of getting infected is higher. The severity of chickenpox is reduced by vaccination.

Most healthy children with chickenpox recover without medical treatment. If the individual is at high risk of complications, antiviral medicine may be prescribed.

Symptoms:

The common symptom of chickenpox is a rash that typically appears 10 to 21 days after exposure. It starts as raised pink or red bumps, progresses to fluid-filled blisters, and eventually forms crusts and scabs. The rash can last about 5 to 10 days. The rash may begin on the chest, face, or back and then spread to every part of the body, including inside the mouth, the eyelids, and the genital area. The blisters normally take about a week to turn into scabs.

Other symptoms that may appear 1 to 2 days before the rash include:

• Fever

• Loss of appetite

• Headache

• Tiredness

Remember to seek medical advice if you experience new, severe, or persistent symptoms.

Causes:

Chickenpox is caused by the varicella-zoster virus (VZV). It is spread through direct contact with the rash or the release of virus-containing air droplets from an infected person coughing or sneezing. It is easily transmitted from infected individuals to those who have never had chickenpox or never been vaccinated.

Risk Factors:

The risk factors of chickenpox include:

Not having had chickenpox as a child or not vaccinated: If you didn’t have chickenpox during childhood or haven’t received the chickenpox vaccine, you are at risk as an adult.

Living with unvaccinated children: Close contact with unvaccinated children under 12 increases the risk.

Occupational exposure: Working in schools or child care settings where exposure to infected individuals is likely.

Weakened immune system: Conditions like HIV/AIDS, cancer, transplants or medications that suppress the immune system, chemotherapy or long-term use of steroids increase susceptibility.

Pregnancy: Especially during the third trimester, pregnant individuals are more vulnerable.

Possible Complications:

Chickenpox is usually a mild disease. However, in some cases, complications can arise. Here are the possible complications:

• Bacterial infections of the skin and soft tissues, including Group A streptococcal infections in children

• Pneumonia (lung infection)

• Inflammation of the brain (encephalitis) or cerebellar ataxia (damage to the part of the brain called the cerebellum)

• Bleeding problems

• Dehydration

• Bloodstream infections (sepsis)

Hospitalization may be necessary for some individuals with serious complications. Fortunately, due to vaccination programs, chickenpox-related deaths are now very rare. However, unvaccinated children and adults can still be at risk. 

Prevention:

Getting the chickenpox vaccine is the most effective approach to prevent chickenpox.  Everyone, including adolescents, children, and adults, should receive two doses of the vaccine if they have never had chickenpox or were never vaccinated. The vaccine is safe and effective, preventing almost all severe cases. However, do not get the chickenpox vaccine if you are pregnant. If you choose to have the vaccinations before becoming pregnant, you should refrain from trying to conceive during the course of the doses or for a month following the last dose of the vaccine.

Check with your doctor if you should get chickenpox vaccine or you should wait if you:

• Have a weakened immune system. This includes those who have HIV or use immune-suppressive medications.

• Are allergic to the antibiotic neomycin or gelatin.

• Have any sort of cancer or are undergoing radiation or medication treatment for cancer.

• Recently received blood products or blood from a donor. 

When to see a doctor?

If you suspect that you or your child has chickenpox, it is essential to consult a doctor promptly. Also, let your doctor know if:

• The rash spreads to one or both eyes.

• The rash becomes very warm or tender. This could indicate that the skin is infected with bacteria.

• You may have more serious symptoms along with the rash. Look for symptoms such as dizziness, fast heartbeat, new confusion, shortness of breath, shakiness, loss of coordinated muscular movement, a worsening cough, vomiting, stiff neck, or fever above 102°F (38.9°C).

• Someone in your home is pregnant.

• You live with individuals who have never had chickenpox and who have not received the vaccination yet.

• You live with someone who has a disease or takes immune-suppressive medication.

Diagnosis:

Most often, healthcare providers diagnose chickenpox based on the characteristic rash. The rash typically appears in three phases:

• Raised pink or red bumps.

• Small, fluid-filled blisters.

• Crusts and scabs that cover the broken blisters.

In some cases, lab tests (such as blood tests or a tissue study of affected skin samples) can confirm the diagnosis.      

Treatment:

Most healthy children with chickenpox recover without medical treatment. The disease just needs to run its course. For relief from itching, some children may take antihistamines.

Avoid use of aspirin or aspirin-containing products to relieve fever from chickenpox. Aspirin use in children with chickenpox is associated with Reye’s syndrome, a severe condition affecting the liver and brain. Instead, use non-aspirin medications such as Acetaminophen to manage fever.

For individuals at high risk of complications (e.g., pregnant women, people with weakened immune systems, chronic skin or lung disease, healthy people above 12 years of age and people receiving long-term salicylate therapy or steroid therapy), antiviral drugs like Acyclovir may be prescribed. These medications work best when taken within the first 24 hours of the rash appearance.

Home Remedies:

You may take a few steps at home to help relieve the symptoms of chickenpox and prevent transmission:

• Use calamine lotion or take cool baths with baking soda, colloidal oatmeal or uncooked oatmeal to relieve itching.

• Keep fingernails short and minimize scratching to prevent the virus from spreading to other people and to help prevent skin infections. If you do scratch a blister accidentally, wash your hands with soap and water for 20 seconds.

• If mouth sores from chickenpox develop, eat a soft, bland diet.

• Avoid scratching the skin, as it may leave scars and slow healing. It may also increase the risk of an infection developing in the sores.

• Avoid close contact with people known to have chickenpox.

• Do not share objects with infected individuals.

• Isolate household members with chickenpox to prevent its spread.

• Disinfect surfaces touched by an infected person.