Chickenpox Health Article

Treatment

In most cases, it is enough to keep children comfortable while their own bodies fight the illness. Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Lotions containing antihistamines are not proven more effective. Trim the fingernails short to reduce secondary infections and scarring.

Safe antiviral medicines have been developed. To be effective, they usually must be started within the first 24 hours of the rash. For most otherwise healthy children, the benefits of these medicines may not outweigh the costs. Adults and teens, at risk for more severe symptoms, may benefit if the case is seen early in its course

In addition, for those with skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or those who have recently taken steroids, the antiviral medicines may be very important. The same is also true for adolescents and children who must take aspirin on an ongoing basis.

Some doctors also give antiviral medicines to people in the same household who subsequently come down with chickenpox. Because of their increased exposure, they would normally experience a more severe case of chickenpox.

DO NOT USE ASPIRIN for someone who may have chickenpox. Use of aspirin has been associated with Reyes Syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen may be used.

Expectations (prognosis)

The outcome is generally excellent in uncomplicated cases. Encephalitis, pneumonia, and other invasive bacterial infections are serious, but rare, complications of chickenpox.

Complications

• Women who get chickenpox during pregnancy are at risk for congenital infection of the fetus.
• Newborns are at risk for severe infection, if they are exposed and their mothers are not immune.
• A secondary infection of the blisters may occur.
• Encephalitis is a serious, but rare complication.
• Reye's syndrome, pneumonia, myocarditis, and transient arthritis are other possible complications of chickenpox
• Cerebellar ataxia may appear during the recovery phase or later. This is characterized by a very unsteady walk.

Calling your health care provider

Call your health care provider if you think that your child has chickenpox or if your child is over 12 months of age and has not been vaccinated against chickenpox.

Prevention

Because chickenpox is airborne and very contagious before the rash appears, it is difficult to avoid. It is possible to catch chickenpox from someone on a different aisle in the supermarket, who doesn’t even know they have chickenpox!

A chickenpox vaccine is part of the routine immunization schedule. It is about 100% effective against moderate or severe illness, and 85-90% effective against mild chickenpox. Parents often express concern that the immunity from the vaccine might not last. The chickenpox vaccine, though, is the only routine vaccine that does not require a booster. However, a higher dose of the vaccine given later in life may reduce the incidence of herpes zoster (shingles). Reimmunization with the high dose is currently being considered by vaccination experts.

Talk to your doctor if you think your child might be at high risk for complications and might have been exposed. Immediate preventive measures may be important. Vaccine given early after exposure may still reduce the severity of the disease.

References

American Academy of Pediatrics. Committee on Infectious Diseases. Varicella vaccine update.Pediatrics. 2000 Jan;105(1 Pt 1):136-41. Review.

Burton A. Vaccine vanquishes varicella. Lancet Infect Dis. 2002; 2(4): 202.

Chen TM. Clinical manifestations of varicella-zoster virus infection. Dermatol Clin. 2002; 20(2): 267-282.

Long SS. Principles and Practice of Pediatric Infectious Disease. 2nd ed. St. Louis, MO: Elsevier; 2003.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.