Chickenpox

Overview

Chickenpox is an illness caused by the varicella-zoster virus. It leads to an itchy rash with small, fluid-filled blisters. The rash appears 10 to 21 days after exposure to the virus and lasts for about 5 to 10 days. Symptoms that may appear before the rash include fever, loss of appetite, headache, and a general feeling of being unwell. The rash goes through three phases: raised bumps called papules, small fluid-filled blisters called vesicles, and crusts and scabs. Chickenpox is generally mild in healthy children, but it can be more severe in certain groups, such as those with weakened immune systems or pregnant women who haven't had chickenpox. Chickenpox can be spread through direct contact with the rash or through the air when an infected person coughs or sneezes.

Understanding the disease

Symptoms

The symptoms of chickenpox include an itchy rash with small, fluid-filled blisters, fever, loss of appetite, headache, tiredness, and a general feeling of being unwell. The rash goes through three phases: raised bumps called papules, small fluid-filled blisters called vesicles, and crusts and scabs. Chickenpox can also cause blisters in the throat and eyes, and in rare cases, it can cover the whole body. If you or your child experience more serious symptoms such as dizziness, confusion, fast heartbeat, shortness of breath, shakiness, loss of muscle function, worsening cough, vomiting, stiff neck, or a fever higher than 102 F (38.9 C), it's important to see a doctor.

Risk Factors

The risk factors for developing chickenpox include:

1. Not having had chickenpox before or not being vaccinated against it.
2. Being in close contact with someone who has chickenpox, either through direct contact with the rash or breathing in air droplets from a person with chickenpox who coughs or sneezes.
3. Working in child care or school settings without being vaccinated.
4. Having a weakened immune system due to certain medical conditions, such as cancer, HIV, or taking immunosuppressive medications.
5. Pregnant women who haven't had chickenpox.
6. Smoking, which weakens the immune system and increases the risk of complications.

Development

Chickenpox typically develops through three phases:

1. Papules: The initial phase involves raised bumps called papules, which appear on the skin over a few days. These bumps are the first sign of the virus.
2. Vesicles: Shortly after the papules appear, small fluid-filled blisters called vesicles form. These blisters develop rapidly, typically within a day, and then burst and leak their fluid.
3. Crusts and scabs: As the vesicles break, crusts and scabs form on the broken blisters. The scabs take a few more days to heal completely. During this phase, the rash may still be itchy. Throughout the course of the illness, new bumps can continue to appear, leading to a combination of bumps, blisters, and scabs on the skin at the same time.

Assessment and Diagnosis

Triage

You should see a doctor if chickenpox is suspected, especially if there are more serious symptoms along with the rash such as dizziness, new confusion, fast heartbeat, shortness of breath, shakiness, loss of the ability to use muscles together, a cough that becomes worse, vomiting, stiff neck, or a fever higher than 102 F (38.9 C). If the rash spreads to one or both eyes or the rash gets very warm or tender, it might be a sign that the skin is infected with bacteria, and medical attention is necessary. Additionally, if you live with people who've never had chickenpox and haven't gotten the chickenpox vaccine yet, you should consult with a healthcare provider to discuss the appropriate course of action.

Diagnosis

Chickenpox can be diagnosed based on the appearance of the rash and symptoms, such as fever and fatigue. Health care providers may also confirm the diagnosis with lab tests, including blood tests or a tissue study of samples of affected skin. If you suspect you or your child has chickenpox, it's essential to consult a healthcare provider for an accurate diagnosis and appropriate treatment.

Management and Treatment

Complications

Potential complications of chickenpox may include infections of the skin, soft tissues, bones, joints, or bloodstream caused by bacteria, dehydration, pneumonia, swelling of the brain (encephalitis), toxic shock syndrome, Reye's syndrome, and, in rare cases, death. Chickenpox complications are more likely in newborns and infants, teens and adults, pregnant women who haven't had chickenpox, people who smoke, and those with weakened immune systems. The chickenpox vaccine is safe and effective in preventing the disease and its complications. Side effects of the vaccine are generally mild and may include pain, redness, soreness, and swelling at the injection site.

Prevention

Chickenpox can be prevented through vaccination. In the United States, the chickenpox vaccine, also known as the varicella vaccine, is available and recommended for people of all ages. Two chickenpox vaccines are licensed for use: Varivax, which contains only the chickenpox vaccine, and ProQuad, which combines the chickenpox vaccine with the measles, mumps, and rubella vaccine. The vaccine is highly effective in preventing chickenpox, with experts reporting that two doses of the vaccine can prevent illness over 90% of the time. If you've already had chickenpox or have been vaccinated, you are generally immune to the disease. To further reduce the risk of infection, it's important to wash your hands frequently and avoid touching your eyes, nose, or mouth with unwashed hands.

Treatment

If you or your child is at high risk of complications, your healthcare provider may suggest antiviral medicine, such as acyclovir, to fight the virus and lessen the symptoms of chickenpox. Antiviral drugs like valacyclovir and famciclovir may also help make the illness less severe. In some cases, your provider may recommend the chickenpox vaccine after exposure to the virus to prevent the disease or make it less severe. Treatment for complications may include antibiotics for infections and antiviral medicine for brain swelling (encephalitis). It's essential to follow the advice of your healthcare provider regarding the most appropriate treatment for your specific situation.

Preparing for medical consultation

To prepare for an appointment for chickenpox, you should:

1. Be aware of any pre-appointment restrictions: Ask your healthcare provider if there are any special instructions you should follow before the appointment, such as avoiding close contact with others.
2. Write down symptoms: Note any symptoms you or your child has experienced, including the onset date and duration of each symptom.
3. Gather key personal information: Prepare to share details about recent exposure to people who might have had chickenpox, any other health problems, and a list of medications being taken.
4. Make a list of medications: Compile a list of all medications, vitamins, or supplements that you or your child is currently taking.
5. Bring previous medical records: Ensure that you have any relevant previous scans, X-rays, and medical records to share with your healthcare provider.
6. Consider bringing a support person: Consider bringing a family member or friend who can help remember information, ask questions, and act as an advocate during the appointment. Remember to be as thorough and detailed as possible when discussing your concerns with your healthcare provider, and don't hesitate to ask any questions you may have.