Understand the Symptoms of Chickenpox and How to Manage Them

What is Chickenpox?

Chickenpox is a contagious infection caused by the varicella-zoster virus (VZV). It commonly affects babies and children, but adults can also suffer from it. The significant sign of chickenpox is a severely itchy skin rash with red eruptions. After the first several days, the blisters tear and start to leak. Next, crust and scab forming occurs followed by healing. Babies less than two years of age are most susceptible to chickenpox and above 90% of cases occur in babies, although it is generally mild. The blisters formation usually starts at the chest, back, and face. In some severe cases, it may involve the mouth, nose, eyes, and genitals.[i] Other important risk factors of VZV infection are:

• Premature babies
• Not having had the VZV infection before
• No vaccination against the VZV infection
• Autoimmune disease
• Pregnant women
• Living with children
• Patients with cancer

Symptoms of chickenpox

Babies with the chickenpox virus do not usually show any symptoms until 10 to 21 days after contact.

• The infection usually starts with a feeling of tiredness, fever, and sleeping more than usual.
• After 3 to 5 days, an itchy rash begins. This rash initially appears as red dots which spread into crops of minor blisters over the face, chest, abdomen, and back. In many babies, the infection stops at this stage and recovery begins.
• In some severe cases, these soon appear on the rest of the body, including the mouth, eyes, nose, ears, and genitals. The blisters are itchy and form periodically. New blisters form when older ones scab over and dry up. The rash leaves scars when the blisters or scabs are scratched or the sores get superinfected.
• Chickenpox may last anywhere between 5 to 10 days. Meanwhile, the rash comes in waves and it is usual to see blisters, bumps, red spots, sores, and scabs all at the same time.[i]

Read Is chickenpox shingels? Or whats the difference?

How contagious is Chickenpox?

Chickenpox is a highly contagious disease and spreads easily from an individual with chickenpox. Chickenpox can transmit through different routes:

• Transmission through direct contact from person-to-person (by saliva).
• Indirect transmission via blister fluid that touches objects like toys, utensils, etc.
• Aerosol transmission by contaminated droplets produced during coughing and sneezing.

Babies with chickenpox become contagious one to two days before the onset of symptoms, such as the rash, until crust or scab formation on all blisters. Vaccinated babies who get chickenpox develop eruptions that don’t crust; these patients are considered contagious until no new lesions have appeared for one day.

It takes about 10 to 20 days for a person to develop chickenpox after contact with an infected person. Vaccinated people can also spread the disease if they are carrying the varicella infection. For most people, getting the varicella infection once provides life-long immunity, but some people are likely to acquire chickenpox more than once. Babies who develop shingles (another disease caused by VZV) can also get chickenpox via the fluid present in blisters.[i]

How to diagnose Chickenpox (a doctor’s job)

The diagnosis of chickenpox is relatively easy. Physicians can make a confirmed diagnosis by examining the rash and asking about the history of other symptoms and exposure to the VZV virus. For unconfirmed cases, additional tests are applied, including:

• Blood test: A blood test can be done to confirm if you are immune to the disease or carrying an active infection. Blood is taken and checked to see whether any VZV antibodies are present.
• Viral test: Sometimes, a viral culture is done instead of a blood test. A fluid sample is taken from an eruption and sent to the laboratory where the specimen cultured. After a while, it is examined for the varicella-zoster virus.

In some other cases, the physician may prescribe additional testing. These cases include pregnant women, vaccinated babies, babies with a mild disease, and the presence of atypical symptoms.

Some other diseases can also cause an itchy, raised red rash or blisters on the skin. The following skin disorders result in rashes which are similar to and can be confused for chickenpox:

• • Scabies
  • Impetigo
  • Insect bites
  • Contact dermatitis
  • Herpes simplex virus
  • Drug reaction[i]

3 good treatments 

Some common over-the-counter drug options are available to relieve symptoms of chickenpox, like itching, pain, etc., if they become too much to bear or are troublesome to the body during day or night.

Calamine Lotion

Calamine lotion is an over-the-counter topical formulation containing zinc carbonate or zinc oxide. It relieves the itch when applied directly to the affected part of the body and allowed to dry. It is now also available in clear forms. Calamine lotion comes in different compositions, so it’s important to follow any precautions printed on the bottle. Take care not to apply lotion to the eyes and mucous membranes of the nose, mouth, genitals, and anus as it can cause severe irritation in these parts.

Acetaminophen (Tylenol)

Chickenpox characteristically causes viral symptoms like fever, fatigue, headache, and muscle aches. Acetaminophen (Tylenol) or Ibuprofen (Motrin), both non-steroidal anti-inflammatory drugs (NSAIDs), can relieve many of these viral symptoms. The dose is adjusted properly for the kids according to age and weight. Aspirin should not be used for babies due to the adverse effects (Reye’s syndrome). Reye’s syndrome is a complex of symptoms such as nausea, vomiting, lethargy, confusion, violent behavior, irritability, unresponsive baby, seizures, and sleepiness. Make sure not to give any medication containing aspirin to a baby or child under 16.

Oral Antihistamines

For severe itching, the oral antihistamine Diphenhydramine (Benadryl) is effective. This medication commonly causes drowsiness, so it’s best to take it at night. For daytime use, new generation antihistamines such as Loratadine (Claritin), Cetirizine (Zyrtec), or Fexofenadine (Allegra) cause less sedation.

If your baby is exposed to a patient of chickenpox but does not yet have symptoms, the physician may prescribe an injection containing immunoglobulin. This can help prevent severe chickenpox.[i]

4 things you can do yourself

Chickenpox can be curable using different home remedies. Dermatologists mention the following tips:

1. Chickenpox is very contagious. Keep your baby at home and limit exposure to other people until all chickenpox blisters have turned to scabs and no new blisters form. It typically takes about 5 to 6 days for the blisters to become scabs.
2. Soak in colloidal oatmeal baths; colloidal oatmeal will help relieve the itch. Oatmeal contains compounds such as beta-glucans which may reduce the intensity of inflammation and itchiness. Add the oatmeal under the outlet while the tub is filling with warm water. After a bath, use a topical ointment like petroleum jelly, calamine lotion, or anti-itch lotion. Avoid using topical antibiotics as they may cause an anaphylactic reaction.
3. Keep your baby’s fingernails trimmed short; this will avoid skin infections caused by scratching the blisters. Also, put gloves or socks over their hands to stop scratching.
4. To relieve fever, use non-aspirin medicines such as acetaminophen or ibuprofen. Relieve itchiness by oral antihistamines.⁵

Read Can you get chickenpox with vaccine?

Vaccination and prevention

• Babies cannot get the vaccine until they are at least one year old. However, cases of chickenpox in babies under 12 months went down by 90 percent. The best method to prevent chickenpox in a baby under one year of age is to have the chickenpox vaccine. Everyone, including babies, adolescents, and adults, can get two doses of the chickenpox vaccine if they’ve never suffered from chickenpox and never got vaccinated in the past. Receiving two doses of the chickenpox vaccine is around 94% effective in preventing the disease. Babies who receive the vaccination can still suffer from chickenpox, but of a mild severity.

  Babies should get the chickenpox vaccine as per their regular vaccine schedule:

  • Between 12-15 months of age (1st dose)
  • Between 4-6 years of age (2nd dose)

  Adults and children that aren’t vaccinated should get two doses of the vaccine with a month gap.

  Some babies should not get the chickenpox vaccine. This includes those:

• • Who recently got a blood or gamma globulin transfusion
  • With a weakened immune system
  • Who have had an allergic reaction to a prior dose of the chickenpox vaccine
  • On steroids or other medications that weaken the immune system
  • Undergoing radiation or chemotherapy
  • Who are severely ill[i]

Chickenpox in pregnancy

Pregnancy is an intricate process and any disease occurring during pregnancy will result in a more exaggerated response than usual. Chickenpox symptoms take 14 to 16 days to show after infection. Chickenpox during pregnancy may occasionally cause complications; it has been observed that the risk of developing pneumonia increases significantly during pregnancy due to chickenpox infection. The effects of chickenpox while a woman is pregnant depends on the gestational age.

If the woman is infected within chickenpox during the first 20 weeks of pregnancy, there’s a risk that newborn babies may develop a condition called “Fetal varicella syndrome”. This syndrome is a rare condition and occurrence is less than 1%. However, the risk increases to 2% after 20 weeks of pregnancy. It may cause grim complications like eye defects in newborns (such as cataracts), shortened limbs, brain damage, and scarring. Chances of premature birth (birth before 37 weeks of gestation) increases. If a woman is infected with chickenpox a week before or a week after delivery of the baby, serious complications arise. This infection can be fatal. If a woman has chickenpox during pregnancy or seven days after delivery, she should urgently see her doctor. Interaction with anybody who is already infected should be strictly avoided.[i]

References

[1] Judith Breuer, H. (2020). Chickenpox. Retrieved 14 May 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275319/

[2] Welsby, P. (2006). Chickenpox, chickenpox vaccination, and shingles. Postgraduate Medical Journal, 82(967), 351-352. doi: 10.1136/pgmj.2005.038984

[3] Kharchenko, G., & Kimirilova, O. (2017). THE COURSE OF CHICKENPOX IN ADULTS AND CHILDREN. CHILDREN INFECTIONS, 16(1), 56-60. doi: 10.22627/2072-8107-2017-16-1-56-60

[4] Watkins, J. (2011). An overview of the diagnosis and treatment of chickenpox. British Journal Of School Nursing, 6(7), 324-328. doi: 10.12968/bjsn.2011.6.7.324

[5] Jonathan Cohen, J. (2020). Chickenpox: treatment. Retrieved 14 May 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468609/

[6] Breuer, J. (2006). Vaccines against chickenpox and zoster. Journal Of Clinical Virology, 36, S4. doi: 10.1016/s1386-6532(06)80704-3 

[7] Lamont, R., Sobel, J., Carrington, D., Mazaki-Tovi, S., Kusanovic, J., Vaisbuch, E., & Romero, R. (2011). Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG: An International Journal Of Obstetrics & Gynaecology, 118(10), 1155-1162. doi: 10.1111/j.1471-0528.2011.02983.x