Chickenpox (varicella)

Question 1

Onset

Answer 1

Children: no prodrome

Adults: prodrome (myalgia, fever, headaches) for 2–3 d

Question 2

Rash

Answer 2

Centripetal distribution, inc. oral mucosa

Scalp lesions can become infected

‘Cropping’ phenomenon:

• vesicles
• papules
• crusting lesions present together

Pruritic

Question 3

Treatment

Answer 3

Treatment is symptomatic

• usually no specific therapy is required.

Reassurance that lesions do not usually scar

Rest in bed until feeling well

Give paracetamol for fever

Drink ample fluids; keep diet simple

Calamine lotion to relieve itching

Daily bathing with sodium bicarbonate (½ cup added) or Pinetarsol (preferable) in bath water

Avoid scratching

Antihistamines for itching if necessary

Valaciclovir or similar agent in patients >14 yrs

• commence only during first 3 d of eruption
• to help avoid complications, inc. scarring

Question 4

Exclusions

Answer 4

Patient 7 d or until blisters dry

• contacts nil apart from immune deficient

Question 5

Prevention

Answer 5

Varicella vaccine from ≥18 mths of age

• usually at 18 mths