Chickenpox

It is a very common and highly contagious disease, still suffering from the majority of children. It usually occurs in the first semester of the year and in the form of epidemic outbreaks in schools and nurseries.

Although it is, in general, a benign disease, it is interesting to know it for its possible confusion with other similar diseases and because, sometimes, it can have important complications and even, if pregnant women suffer from it, affect the fetus.

Why is it produced?

The Chickenpox is caused by a virus, the same as the herpes zoster . Generally, in children when they become infected for the first time, chickenpox occurs and in those people with attenuated immunity, when they are reinfected by the virus, herpes zoster originates. Chickenpox outbreaks can occur from contact with people with shingles.

Children with chickenpox must be isolated, at home, until the vesicles have dried up and they cannot attend school or daycare, or camps, etc. No attempt should be made to isolate siblings at home as it is useless. It is important that they avoid contact with people who have not suffered from it and, above all, with pregnant women.

Chickenpox symptoms

The incubation period for chickenpox (time elapsed between contact with the virus and the onset of the disease) is usually long, 2 to 3 weeks, so many times the notion of contagion is lost. This is produced by direct contact and by droplets of saliva in the air.

Patients are infectious from approximately 24 hours before the appearance of the rash (the pimples and blisters) until all the lesions have crusted (7 to 10 days later).

The rash appears quickly. It usually begins as a bunch of small red papules that develop into clear, tear-like vesicles. Then they darken, break easily and crust over. During 3 or 4 days, a multitude of vesicles continue to appear that begin on the trunk and spread to the face and scalp. In the extremities they are less conspicuous, although they can spread to all mucous membranes (mouth, conjunctiva, genitalia, etc.).

The evolution in outbreaks is very typical and not all the lesions appear at the same moment, but some do so before others, finding a coincidence of all of them in different evolutionary phases: macula, papule, gallbladder, pustule and scab. The intensity of the disease ranges from few lesions and few signs of disease to the appearance of hundreds of vesicles and general malaise and high fever .

The itching is constant and very annoying. In adults it is a more serious infection than in children. In general, the fever is higher, the rash more abundant, and complications occur more frequently.

Complications that chickenpox can have

Complications are more common in children younger than 1 year or older than 15 years.

The most common complication is secondary bacterial infection from scratching skin lesions. If it is very intense and deep, scars may remain. Pneumonia is rare in children, although one fifth of adults have it. Eye infections ( conjunctivitis ) are usually benign. Complications such as purpura (hemorrhages), encephalitis , hepatitis, and arthritis are very rare. Reye’s syndrome is a serious disease with neurological and liver symptoms that has been seen in children who had chickenpox and had taken aspirin. There are several types of chickenpox that are very rare: hemorrhagic, bullous (large blisters).

In babies whose mothers had chickenpox during the first month of pregnancy there is a tendency to be smaller, and may have malformations such as skin scars, eye abnormalities, seizures and mental retardation. They also tend to be excessively prone to infection. If the mother suffers from chickenpox 5 days before or 2 days after delivery, the affectation of the newborn can be very serious, and three out of every ten children may die.

How is it diagnosed?

The diagnosis of the disease is carried out mainly with the clinic presented by the patient, relying on the history of having been in contact with someone who suffers or has suffered from the disease.

The unequivocal confirmation of the diagnosis is possible by isolating the virus in cells or by raising antibodies in the patient’s serum.

Chickenpox treatment

Symptomatic treatment should be aimed at relieving itching using local antipruritic agents and oral antihistamines. The effects of scratching will be minimized if the child has well-trimmed and clean fingernails.

Daily changes of bedding and clothing and antiseptic baths or oatmeal soaps reduce the incidence of secondary bacterial infection. If this occurs, topical and systemic antibiotics are indicated.

Aspirin should not be used to lower fever due to the risk of producing Reye’s syndrome. Acyclovir is an effective treatment for chickenpox, although it should be reserved for severe cases due to the cost of therapy. It is advisable to start this medicine before the third day of illness.

In some cases (pregnant women, people with very diminished defenses and newborns) who have been in contact with varicella, within the first 72 hours, they should be given varicella-zoster gamma globulin, to prevent them from developing the disease.

However, true prevention will be carried out in a generalized way in the very near future with the inclusion in the vaccination schedules of the chickenpox vaccine, so that this disease, in addition to not bothering our children so much, will dramatically decrease the truancy.

Although it is beginning to be used in several countries (USA, Japan and some European countries), in Spain it is not available in pharmacies, as it is not approved for use in healthy children, being found only in hospitals.

Myths and beliefs about chickenpox

• There is a misconception that with chickenpox bathing is prohibited, when the reality is the opposite.
• Also the use of talcum for the skin seems essential. Although they often relieve itching, they are generally too dry while making the child uncomfortable.
• This disease is not spread by third parties or indirect contacts.
• Chickenpox does not recur, except in very exceptional cases. It does not happen again even if the first time few pimples came out.
• It is not contagious before it flares, except perhaps in the 24-48 hours before.
• It is also believed that if the sun hits them they can get hot and stupid. It does not hurt to go outside or the wind. Of course, you should avoid sunbathing because white spots on the skin can be very difficult to remove.
• Chickenpox can be suffered at any age, including newborns and the elderly.