How to Recognize Chickenpox

Chickenpox is caused by the Varicella Zoster virus, which belongs to the Herpes virus family. It was once considered a common disease among children, but the introduction of the chickenpox vaccine has significantly reduced its spread. However, you or your child could still contract chickenpox at any time. To identify chickenpox, it is essential to recognize the symptoms associated with this illness.

Observe skin symptoms. After experiencing a runny nose and sneezing for about 1 or 2 days, you may notice red spots appearing on the skin. These spots usually start on the chest, face, and back, tend to itch, and can spread rapidly to other areas.

• The red spots will turn into red bumps and eventually become blisters. These red spots contain the virus and are highly contagious. The blisters will crust over after a few days. Once the blisters have crusted over, the patient is no longer contagious.
• Insect bites, scabies, other viral rashes, impetigo, and syphilis can resemble chickenpox.

Be cautious of cold-like symptoms. The first sign of chickenpox is mild cold symptoms, including a runny nose, sneezing, and coughing. You may even experience a fever up to 39°C. If the patient has been in contact with someone who has chickenpox or has had a mild case of chickenpox (for those who have been vaccinated), these cold-like symptoms could be the initial indication of the disease.

Identify symptoms early to avoid contact with those at risk. Chickenpox is highly contagious and can be particularly dangerous for individuals with weakened immune systems, such as cancer patients undergoing chemotherapy or people living with HIV/AIDS, as well as most young children who have not yet received the chickenpox vaccine, typically administered after 12 months of age.

Understand how the virus spreads. Chickenpox spreads through the air or via direct contact, often through droplets released when sneezing or coughing. The virus is carried in fluids (e.g., saliva or mucus).

• Touching an open wound caused by the virus or inhaling the virus (such as kissing someone with chickenpox) can also lead to infection.
• If you have encountered someone with chickenpox, recognizing your symptoms will be easier.

Know the incubation period. Chickenpox does not cause immediate symptoms. Generally, noticeable symptoms may appear 10-21 days after exposure. The rash will continue to appear over a few days, and the blisters will subside after a few days. This means you might experience a combination of a rash, blisters, and crusted blisters simultaneously.

• Approximately 90% of people who have close contact with an infected individual and have not been vaccinated will develop the disease.

Be aware that teenagers and adults face higher risks of complications. While not typically severe, chickenpox still results in numerous hospitalizations, fatalities, and complications in teenagers and adults. The rash and blisters can appear in the mouth, anus, and vagina.

Call a doctor if the patient is at high risk of severe disease. Children over 12, pregnant women, or individuals with weakened immune systems (including those using steroids that affect the immune system), or those with asthma or eczema, are at higher risk of experiencing more severe symptoms.

Seek medical advice if the condition worsens or if there's a risk of severe complications. Not everyone will be prescribed medication for chickenpox. In many cases, doctors will avoid prescribing strong medications to children unless the infection could lead to pneumonia or other serious issues.

• For optimal results, antiviral medications should be started within 24 hours of the rash's appearance.
• If you have a skin condition like eczema, a lung condition such as asthma, have recently been treated with steroids, or have an immune system issue, antiviral medication may be considered for treating chickenpox.
• In certain cases, pregnant women may also be prescribed antiviral medications.

Avoid using aspirin or ibuprofen. Specifically, do not give these two medications to children, and avoid giving ibuprofen to infants under 6 months old. Aspirin can lead to a serious condition known as Reye's syndrome, and ibuprofen may cause other secondary infections. Instead, use acetaminophen (Tylenol) to treat headaches, body aches, or fever caused by chickenpox.

Avoid scratching the blisters or picking at scabs. Although the blisters and scabs are very itchy, you should refrain from scratching or picking at the rash. Removing scabs can leave scars, and scratching increases the risk of secondary infections. Trim your child's nails if they scratch the blisters.

Cool the blisters. Apply a cold compress to the blisters. Take cool baths. Cold temperatures help alleviate itching and fever associated with chickenpox.

Use calamine lotion to relieve itching. Take cool baths with baking soda or oatmeal, or apply calamine lotion to reduce itching. If this does not help, contact your doctor for a prescription. Cool water and calamine lotion will ease the itching (reducing severity) but won’t fully eliminate the itch until the blisters heal.

• Calamine lotion is available at grocery stores or pharmacies.

Ask your doctor about the chickenpox vaccine. This vaccine is safe and can be administered to children before exposure to the virus. The first dose is given at 15 months of age, and the second dose is given between 4 to 6 years old.

• The chickenpox vaccine is much safer than getting the disease. Most people who receive the vaccine do not experience any issues. However, like any medication, vaccines can cause serious problems such as allergic reactions. The risk of severe complications or death from the chickenpox vaccine is extremely small.

Let your child get chickenpox if they have not received the vaccine. Be sure to discuss this decision with your doctor. Vaccination is a personal choice for parents. However, the older the child gets, the more challenging the illness will be. If you choose not to vaccinate your child or if your child has an allergy to the vaccine, try to expose them to chickenpox after age 3 but before age 10 to reduce the severity of the symptoms and the illness.

Be cautious with a recurrence of chickenpox. Children who have received the vaccine may develop a milder form of the illness. There may be only around 50 spots of rash and blisters on the body. This can make diagnosis more difficult. However, the disease can spread quickly if it becomes more severe.

• Adults are at higher risk of developing a more severe form and face a greater chance of complications.
• So far, vaccination has been preferred over the 'chickenpox parties,' where parents intentionally expose their children to the virus. Vaccination may cause mild symptoms, while deliberately exposing your child to chickenpox may result in a more severe case, possibly leading to pneumonia and other serious complications. For this reason, it’s best to avoid 'chickenpox parties.'

Be aware of children with skin conditions, such as eczema. Children with a history of skin conditions may develop many more blisters. This condition can be painful and increases the risk of scarring. You should use the treatments described above to ease itching and consult your doctor about other topical and oral medications to reduce discomfort and pain.

Be cautious of secondary bacterial infections. The area with blisters can become infected with bacteria. The blisters will become warm, red, and painful to the touch, possibly oozing pus. The pus will be thick and darker compared to the clear fluid from the blisters. Contact your doctor if you notice these changes on the skin. Secondary infections need to be treated with antibiotics.

• Bacterial infections can also affect tissues, bones, joints, and even blood vessels, leading to blood infections.
• Infections are dangerous and require immediate medical attention.
• Symptoms of a secondary infection affecting bones, joints, or blood include:
• A fever over 39°C
• The infected area feels warm and painful to touch (bones, joints, tissues)
• Painful joints during movement
• Shortness of breath
• Chest tightness
• Progressively worsening cough
• Fatigue. Most children will have a fever when they have chickenpox, but it will pass quickly. Despite cold symptoms, children still play, laugh, and want to go outside. In contrast, a child with sepsis (blood infection) will be lethargic, want to sleep more, have a fever over 39°C, a rapid heart rate, and increased respiratory rate (over 20 breaths per minute).

Be wary of other serious complications from chickenpox. While not common, complications from chickenpox can be very serious and may even be fatal.

• Dehydration occurs when the body lacks enough water to function. It affects the brain, blood, and kidneys first. Signs of dehydration include: reduced or concentrated urine, fatigue, weakness, dizziness, or rapid heart rate.
• Pneumonia, with symptoms such as excessive coughing, labored breathing, or chest pain
• Bleeding issues
• Infections or encephalitis. The child becomes lethargic, sleepy, and complains of headaches. They may become confused or hard to wake up.
• Septic shock

Be cautious of shingles (Herpes Zoster) in adults, especially after age 40, if you had chickenpox as a child. Shingles is a painful, blistering rash that appears on one side of the body, on the torso or face, and may cause tingling sensations. It is also caused by the Varicella Zoster virus. This virus lies dormant in the body until the immune system weakens, typically as we age. The pain, often a burning sensation, and tingling usually subside within a few weeks, but lasting damage may occur to the eyes or other body parts. Post-herpetic neuralgia, a painful nerve condition, may arise after shingles, which is difficult to treat and can be caused by the shingles infection.

• Call your doctor immediately if you suspect you have shingles to receive antiviral medication, especially if caught early. Adults may be able to receive a vaccine to prevent shingles.