Symptoms
The disease begins with symptoms similar to a cold or flu, with elevated temperature, fever, feeling sick, weakness, and fatigue. Within about 24 hours, the typical rash appears all over the body and develops within a few days. It is initially blotchy and then filled blisters form, which break open and crust over. The rash is surrounded by redness and accompanied by itching. It forms mainly on the trunk and face and less on the extremities. More blisters may develop within a few days. © Lucille Solomon, 2011 http://www.lucille-solomon.com
Causes
This is a viral infectious disease caused by the varicella zoster virus. The virus can cause two diseases. First, chickenpox when first infected in childhood, and second, shingles when reactivated in adulthood, especially in older people.
Transmission
The disease is highly contagious, and there is high population infestation in Europe. More than 90% of adults are seropositive. Infection occurs from person to person via respiratory secretions or via fluid released from vesicles. Chickenpox can also be transmitted from patients with shingles, for example from grandfather to grandchildren. The time from infection to the outbreak of the disease is between 8 to 28 days. Local outbreaks often occur in day care centers, kindergartens, and schools.
Duration of contagiousness
Children can return to school or day care when the last vesicle is cured and dried up and no new rashes appear.
Complications
In preschool-aged children, the disease is usually mild and passes on its own. Nevertheless, chickenpox is not harmless, as severe complications can occur as a result. A severe course is more common in adults, pregnant women, immunocompromised people, the elderly, and people from southern countries. Possible complications include, for example, bacterial infections, pneumonia, central nervous system disorders such as encephalitis, meningitis, and infestation of internal organs. In pregnant women, transmission to the unborn child is possible, and pregnant women are at significantly increased risk for complications.
Diagnosis
Diagnosis is usually made in medical treatment on the basis of the clinical picture. A number of skin diseases that can be confused with chickenpox must be ruled out.
Nonpharmacologic treatment
Cold compresses, baths, and washes help to relieve itching. Nails can be cut short to prevent children from scratching. Also see the article Itching for detailed information.
Drug treatment
The risk for bacterial infection can be reduced with good skin care (baths, washes, dressings, and antipruritic agents). The following remedies are traditionally used to treat itching and are available in pharmacies and drugstores:
- White shake mixture
- Tannins
- Antihistamines, e.g. dimetindenmaleate drops administered orally for itching (Feniallerg drops) Caution in infants and young children.
- Menthol: menthol powder, menthol shake brush 1%, menthol-containing pile care products, eg Excipial Pruri Lotio caution in infants and young children.
- Other zinc oxide preparations, eg zinc ointments.
- Diphenhydramine + camphor + zinc oxide (Caladryl) Caution with infants and young children because of the camphor.
For the treatment of elevated temperature, paracetamol is the 1st choice. Children with chickenpox should not be given aspirin (acetylsalicylic acid) and ibuprofen (eg, Algifor) is also not recommended. Antiviral medications such as aciclovir (Zovirax, generic) or valaciclovir (Valtrex, generic) are used primarily in adults and high-risk patients. They must be administered as early as possible in the onset of the disease, otherwise they are ineffective. They may reduce the duration and severity of symptoms. Use in children is controversial because the course is usually benign.
Prevention
For prevention, contact with people with the disease should be avoided. Children with chickenpox should not go to kindergarten or school until the rash has crusted over.Vaccines are available (e.g. Varivax), see under chickenpox vaccination. However, some parents intentionally let their children play with sick people so that they become infected and go through chickenpox. These are also referred to as “chickenpox parties” (chickenpox parties).