What is Chickenpox?
Chickenpox is a highly contagious childhood viral disease, transmitted either by minute infected droplets from somebody’s throat or nose, or by directly touching infected articles or toys. A person can infect others anywhere from one day before the rash appears to six days after it vanishes. It takes between 14 and 21 days (15 on average) for the viruses to incubate and cause symptoms.
Chickenpox is a common childhood viral illness characterized by the eruption of multiple red bumps, each with a small fluid-filled central blister.
New “crops” of pox erupt for three to five days. Gradually the blisters become crusted, form tiny scabs, and disappear, usually without leaving a scar. The rash is most prominent on the chest, abdomen, and face, but might cover the entire body, including the scalp, genital area, and inside the mouth. In some children, only a few scattered bumps will be visible, while other children are covered from head to toe. Adolescents or adults who develop chicken pox sometimes have a more severe case than do their younger counterparts. Fever may or may not be present. Itching is common and at times can be intense.
The incubation period for chicken pox can range from 11 to 21 days, but most often the time from exposure to onset of symptoms is 14 to 16 days. A child with chicken pox it contagious one or two days before the rash erupts and continues to be so until all the blisters have crusted. This will occur five to seven days after the rash first appears. Children should be kept out of school for about a week. An expectant mother who has never had chicken pox or is uncertain about her immunity to it should avoid exposure to this infection, especially during the first half of her pregnancy. (Chicken pox can cause congenital abnormalities in about 2 percent of newborns whose mothers become infected during the first 20 weeks of gestation. Most infants and children who develop chickenpox recover without any major problem. A few scars may remain, especially in areas where scabs have been repeatedly picked or scratched off. In some cases, bacteria such as streptococci or staphylococci infect a number of pox lesions. A child, who suddenly worsens four or five days into the chicken pox outbreak, especially if fever recurs, should be seen by a physician to check for this complication.
Pneumonia is a rare but potentially serious complication of chicken pox. If a child develops a cough, shortness of breath, and rapid respirations during or shortly after chicken pox, contact a doctor as soon as possible. Reye’s syndrome, a rare but potentially fatal illness affecting brain and liver, has been linked to the use of aspirin during chicken pox and other acute viral infections. Aspirin should not be used to treat fever or aches for anyone, child or adult, who has chickenpox. Persistent vomiting or a significant change in alertness or orientation could indicate this rare complication.
Frequently the youthful patient feels a bit off-colour for a day or so, and runs a mild fever. But the first definite sign is a rash. This comes in waves, and two to four crops can occur in a period of two to six days. All stages can occur simultaneously and in the same region. It usually starts in the scalp, visits the lining of the mouth, then spreads to the body. The rash is usually less obvious on the limbs, and is rarely seen on the palms and soles.
Once seen, the characteristic rash is hard to forget and usually easy to diagnose. All stages can occur, and often a child with a mild attack may have only a few of the typical marks.
It starts with a small reddish mark on the skin. Then a blister forms, rather like a drop of water on a pink base. The top is easily scratched off, through clothing or simple rubbing. Soon after a hard top forms, called the crust. After a while (usually around 13 days) the scab falls off. Sometimes a depression remains in the skin, especially if the blister has become infected with other germs. On the face, this may persist into adult life, much to the dismay of young women who dislike the sight of any facial blemish.
Can serious complications take place? The blisters can become infected, but serious complications are rare. An occasional case of brain infection has been reported (encephalitis with headaches, fever, convulsions), but this is unlikely with most cases.
For most children and adolescents with chickenpox, treatment is supportive: rest, fluids, acetaminophen for fever and aches, and antihistamines such as diphen-hydramine (Benadryl and other brands) as needed to relieve itching. Cool baths and calamine lotion also may relieve itching. These measures (along with gentle parental reminders and trimming the fingernails) can help a child resist the urge to scratch and pick at the blisters and scabs, minimizing the risk of scarring. If sores are present in the mouth, cool liquids (other than citrus or tomato juices, which may sting) and soft foods will be easier for your child to swallow than other foods. There are specific measures for treatment and prevention of chicken pox:
- The prescription medication acyclovir (Zovirax) is sometimes given to reduce the severity of the illness. To be effective it must be started within 24hours of the onset of the eruption.
- Varicella-Zoster Immune Globulin (VZIG) contains antibodies to the chicken pox virus. It is used in specific and very uncommon situations where immediate (although temporary) protection is needed. These situations might include a person with a severely impaired immune system who is exposed to chicken pox or a newborn whose mother develops this illness between five days before and two days after delivery. In the latter case, the newborn will be at risk for a more intense infection because of the immaturity of the immune system at this age combined with a lack of antibody protection from the mother.
- Chicken pox vaccine (Varivax) induces the body’s immune system to create antibodies against the virus and can provide long-term protection. It is now commonly given to infants at the first birth-day but may be used in older children and adults who have never had chicken pox.
There is no specific antibiotic that will cure chickenpox, so therapy is mainly symptomatic. Simple anti-itch lotions may be applied if the skin itch produces a desire to scratch (and increase the risk of further skin infections).
Bathe the patient in a warm bath, and dab dry with a soft towel. Do not rub, for this will break the blisters. Some think infection may be reduced by making the bath water pink by adding a crystal of Condy’s. (Caution: This may stain a white bath, so cleanse the bath quickly and completely afterwards.) Various other antiseptics are also used, but it is not really essential.
If skin scratching is annoying, keeping junior’s nails trimmed short, or giving him gloves to wear will reduce skin trauma. Mouth blisters may be treated with simple saline rinses, cotton wool buds and gargles. However, most children don’t like gargling and many find the method difficult to comprehend. Is it necessary to call the doctor? Most simple cases can be treated by a sensible mother. But if there are obvious complications, marked skin infections, persisting fever, headaches or convulsions, of course it is essential to call the doctor. Never take any risks.
Chickenpox is related to shingles. It seems that the virus, called the varicella virus, which causes a skin eruption in childhood, may in later adult life also cause an extremely painful nerve rash that is also present on the skin. The virus remains in the body for years, slowly smouldering on. In fact, it may persist forever in the body.
Shingles (also known as herpes zoster) commonly occurs on the face or the trunk, usually on one side only. Researchers are working on vaccines and new drugs they hope will ultimately prevent both chickenpox and shingles. According to the medical journals of the world, great progress has been made recently in this field. The drug acyclovir is now successfully used to treat early cases of adult herpes zoster (shingles).