Chicken pox (Varicella)

Chicken pox is a viral infection of childhood.  After an incubation period of 10 to 21 days, the child with Chicken pox will break out with a rash which begins as small red bumps and which very quickly form clear blisters.  The clear blisters then rupture and form dark crusts.  There are, therefore, three skin lesions that are seen with Chicken pox:  first, small red bumps; secondly, small blisters and thirdly, bumps with crusts (scab-like appearances).  These three lesions occur in sequence.  Lesions generally begin on the chest or back and then spread to the face, neck, arms, and legs.  Children usually run fever for several days.  In addition to this, they may have a runny nose, sore throat and/or cough.

Chicken pox is highly contagious.  The child is contagious one day to two days prior to breaking out with the rash and remains contagious until all lesions have completely crusted over and there are no blister lesions.  This generally takes five to seven days from the onset of the rash.  You can usually expect the child will break out with new lesions for two or three days after the first lesion is seen.

Chicken pox is generally a mild illness with no complications.  If complications do occur, the most common one is secondary bacterial infection of the lesions manifested by redness and/or discharge of pus.  You treat these as you would treat impetigo (see section on impetigo).  If the lesions should grow to the size of a quarter, if there is discharge of significant amounts of pus or if there are red streaks coming from the lesion, then you should make an appointment for your child. 

Serious Chicken pox complications are very rare.  These involve pneumonia, encephalitis and a late secondary blood infection with the bacteria which causes strep throat (group A streptococci).  Signs of Chicken pox pneumonia are severe coughing and trouble breathing.  Call us if these should occur.  Signs of encephalitis include headache, stiff neck, vomiting, and lethargy.  If your child should become lethargic and begin vomiting, our office should be called right away.  The main sign of the late strep blood infection is high fever which occurs after the child seems to have overcome the initial Chicken pox infection.  Because strep blood infections can be serious, if your child seems to be recovering from chicken pox with the fever resolving only to have a high fever recur after the initial fever has resolved (usually day 4 - 8), your child will need an appointment. 

Shingles is a reactivation of a Chicken pox  infection and is usually seen in adults, although it can occur in children.  This strange illness occurs because the Chicken pox virus is stored in the nerves near the spinal cord in people who have had Chicken pox in the past.  When the Chicken Pox virus reactivates, it sends infection down the course of the nerve that is affected, causing blister lesions on the skin that are full of Chicken pox virus.  We call this pattern of involvement, dermatomal distribution.  That is, the rash of shingles follows the path of the nerve that is infected with the virus.  Most of the time, shingles results from the occurrence of another viral infection or some other alteration of the immune system. 

People with active shingles are contagious and can spread the Chicken pox virus to others who have not had Chicken pox before.  To put it another way, you can catch Chicken pox from someone with shingles, but you cannot catch shingles from someone else.  Shingles only occurs in someone who has had Chicken pox at an earlier time in their life.  Parents and grandparents do not need to worry about catching shingles from their children with Chicken pox.  Shingles is treated the same as chicken pox unless the child develops painful shingles which should prompt an office visit.  We have elected to use a cortisone type medication in this situation.

Treatment for Chicken pox:

  1. Keep your child away from other susceptible children.  Although Chicken pox is usually a mild illness in children, it can be more severe in adults. If you are unsure as to whether you have had Chicken pox and your child catches the disease or has been exposed to someone with the disease, you need to contact your own physician.
  2. Use Benadryl for itching, and trim the child's fingernails.  If itching is quite severe even with Benadryl, try Aveeno baths.  Scratching lesions can cause secondary infections and scarring.
  3. For the discomfort of fever and the pain of Chicken pox lesions you may use acetaminophen (Tylenol) if you desire.   Please be aware however that fever is actually beneficial in Chicken pox, and should not be treated if your child is comfortable.  Studies have shown that children with Chicken pox who had fever reduction treatment were sick longer, had more lesions and were more likely to scar than children who had no fever control.  For this reason you should avoid as much as reasonably possible the use of fever control medications with Chicken pox.  Aspirin should be strictly avoided in the treatment of Chicken pox because of the potential for Reye's syndrome.
  4. The child is contagious for about a week after the onset of the rash or until all sores have crusted over and have begun to dry.  So, keep your child home from school, daycare or church until all lesions have fully crusted over (5 to 7 days)
  5. A Chicken pox vaccine is available to control the disease.  It is usually given at one year of age.
  6. If begun early in the course of Chicken pox, there is a medication called acyclovir (and other medications in this class) which can shorten the duration that a child has Chicken pox.  Consult us for the use of this medication.

Treatment for Shingles:

  1. Shingles is much less contagious than Chicken pox.  It is acceptable to completely cover the lesions with gauze and tape and allow those individuals to go back to work, school or daycare.  Care must be made to keep the lesions completely covered however.
  2. As with Chicken pox treatment, there is a medication called acyclovir (and other medications in this class) which can shorten the duration that a person has Shingles.  Consult us for the use of this medication.
  3. For painful Shingles, consult us about the use of certain cortisone type medications.