Chickenpox

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Introduction

Chickenpox

Chickenpox is a common illness that mainly affects children and causes an itchy, spotty rash.

Most children will catch chickenpox at some point. It can also occur in adults who didn't have it when they were a child.

It's usually mild and clears up in a week or so, but it can be dangerous for some people, such as pregnant women, newborn babies and people with a weakened immune system.

This page covers:

Symptoms

How to treat it at home

When to get medical advice

How you catch it

Possible complications

Frequently asked questions (FAQs)

Symptoms of chickenpox

The symptoms of chickenpox start one to three weeks after becoming infected.

The main symptom is a rash that develops in three stages:

  • spots - red raised spots develop on the face or chest before spreading to other parts of the body
  • blisters - over the next few hours or the following day, very itchy fluid-filled blisters develop on top of the spots
  • scabs and crusts - after a further few days, the blisters dry out and scab over to form a crust; the crusts then gradually fall off by themselves over the next week or two

Chickenpox is contagious until all the blisters have scabbed over, which usually happens about five or six days after the rash appeared.

Read about the symptoms of chickenpox for more information and pictures of the different stages of the rash.

How to treat chickenpox at home

Chickenpox can usually be treated at home.

You or your child will probably feel pretty miserable and uncomfortable, but treatment can help relieve the symptoms.

The following can help:

  • use paracetamol to relieve fever and discomfort - don't use anti-inflammatory painkillers, such as ibuprofen, as they can sometimes make people with chickenpox very ill
  • use calamine lotion, moisturising creams or cooling gels to ease itching
  • tap or pat the skin rather than scratching it - it's important to avoid scratching because this can lead to further problems
  • drink plenty of fluids to stay hydrated

You should also take steps to stop chickenpox spreading, such as staying away from school or work until the last blister has scabbed over.

Read more about how to treat chickenpox.

When to get medical advice

Chickenpox is normally mild and gets better on its own. But some people can become more seriously ill and need to see a doctor.

It's a good idea to contact your GP or NHS 111 for advice if:

  • you're not sure if you or your child has chickenpox
  • your baby is less than four weeks old and has chickenpox
  • you develop chickenpox as an adult
  • the symptoms haven't started to improve after six days
  • you've been in contact with someone who has chickenpox (or you have symptoms) and you're pregnant or have a weakened immune system
  • you or your child has signs of chickenpox complications, such as swollen and painful skin, difficulty breathing or dehydration

Also consider getting advice if you're originally from a country near the equator (the tropics) and you've been in close contact with someone who has chickenpox.

Chickenpox is much more common in adults from these areas and you may need treatment to help stop you becoming seriously ill.

How you catch chickenpox

Chickenpox is caused by a virus that spreads very easily to people who haven't had it before. If you have had it before, you'll usually be immune for life.

The infection is spread in the fluid found in chickenpox blisters and the droplets in the coughs or sneezes of someone with the infection.

You can catch chickenpox from:

  • contaminated surfaces
  • contaminated objects, such as toys or bedding
  • touching chickenpox blisters or the shingles rash
  • face-to-face contact with an infected person, such as having a conversation
  • being in the same room as an infected person for 15 minutes or more

Someone with chickenpox is infectious from one or two days before the rash appears until all the blisters have dried out and crusted over.

Possible complications

Most people with chickenpox will make a full recovery. But occasionally serious complications can occur.

These are more common in adults, pregnant women, newborn babies and people with weakened immune systems.

Possible complications include:

  • a bacterial skin infection - this can cause the skin to become red, swollen and painful
  • a lung infection (pneumonia) - this can cause a persistent cough, breathing difficulties and chest pain
  • pregnancy problems - including the infection spreading to the unborn baby

Some people with chickenpox may develop shingles later in life. This is a painful, blistery rash caused by the chickenpox virus becoming reactivated.

Read more about the complications of chickenpox.

Chickenpox FAQs

Symptoms

Symptoms

The main symptom of chickenpox is a red rash made up of spots or blisters.

It usually takes between one and three weeks for symptoms to appear after becoming infected (the incubation period).

Early symptoms

Sometimes other symptoms may start a day or two before the rash appears.

These can include:

  • feeling tired and generally unwell
  • a high temperature (fever) of 38C (100.4F) or over
  • feeling sick
  • headache
  • aching, painful muscles
  • loss of appetite

Not everyone has these symptoms. They tend to be more common and more severe in older children and adults with chickenpox.

Chickenpox rash

The chickenpox rash develops in three main stages.

1) spots

The rash starts off as small, raised red spots.

The spots often first appear on the face or trunk before spreading to other parts of the body.

There may just be a few spots or there may be hundreds covering most of the body.

Sometimes spots can appear on the palms of the hands, the soles of the feet, inside the ears or mouth, or around the bottom or genitals.

2) blisters

During the following hours or the next day, the spots develop a fluid-filled blister on top.

The blisters may be very itchy, but it's important not to scratch them.

Scratching could spread the infection to others and increases the chances of complications such as a more serious skin infection.

3) scabs and crusts

Over the next few days, the fluid in the blisters turns cloudy and the blisters begin to dry out and scab over.

New spots may keep appearing for a few days after the rash begins, so there may be a mix of spots, blisters and scabs at the same time.

Chickenpox is contagious until every blister has scabbed over, which usually occurs by around five or six days after the rash started.

The scabby crusts will fall off by themselves over the next week or two.


Treatment

Treatment

Chickenpox is usually mild and can be treated at home. Most people feel better within a week or so.

There's no cure, but the treatments below can help relieve the symptoms while the body fights the infection.

It's also important to take steps to prevent chickenpox spreading, such as staying off work or school until the last blister has dried and crusted over.

Painkillers

Use paracetamol if you or your child have a high temperature (fever) and feel uncomfortable.

Paracetamol is safe for most people to take - including pregnant women and children over two months of age. Special liquid versions are available for young children and babies.

Don't use anti-inflammatory painkillers, such as ibuprofen, as they can sometimes make people with chickenpox very ill. Never give aspirin to a child under 16 as it can be dangerous for them.

Always read the packet or leaflet that comes with the medicine to check if it's suitable and how much to take. Speak to a pharmacist or your GP if you're unsure.

Prevent itching and scratching

Chickenpox can be very itchy, but it's important not to scratch the spots as it can increase the chances of the skin becoming infected with bacteria and could result in scarring.

It can help to:

  • keep nails short and clean
  • tap or pat the skin instead of scratching it
  • wear cotton gloves at night (or socks over hands)
  • bathe in cool or lukewarm water - dab or pat the skin dry afterwards, rather than rubbing it
  • wear loose, smooth cotton clothing

You can also buy calamine lotion, moisturising creams, cooling gels or an antihistamine medicine called chlorpheniramine to help reduce itching and soothe the skin.

Food and drink

It's important to drink plenty of fluids to avoid dehydration.

Water is better than sugary, fizzy or acidic drinks - particularly if you or your child has chickenpox spots in the mouth.

Sugar-free ice lollies are also a good way of getting fluids into children and can help soothe a sore mouth.

Avoid sharp, hard, salty or spicy foods that may make the mouth sore. Soft, cool foods are best, such as soup that has been left to cool down.

If you breastfeed or bottle feed your baby, continue to give them feeds regularly.

Stronger treatments from a doctor

Antiviral medication or a treatment called immunoglobulin may be recommended if you're at risk of developing severe chickenpox.

Those at risk include:

  • pregnant women
  • adults, especially those who smoke
  • newborn babies under four weeks old
  • people with a weakened immune system (the body's defence system), such as people with HIV, those taking high doses of steroid medication and those having chemotherapy

Antiviral medication

An antiviral medicine called aciclovir may be recommended if you're at risk of severe chickenpox and you already have symptoms.

It ideally needs to be started within 24 hours of the rash appearing. It doesn't cure chickenpox, but makes the symptoms less severe.

It's normally taken as tablets five times a day for seven days.

Immunoglobulin

Immunoglobulin is a treatment given by injection that can help prevent severe chickenpox if you've been exposed to someone with the infection but don't have any symptoms yet.

It's sometimes given to pregnant women, people with a weakened immune system and newborn babies who've been exposed to the chickenpox virus and haven't had the infection before.

Antibodies
Antibodies are your body's natural defence against any foreign antigens that enter your blood. An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Complications

Complications

Chickenpox is usually mild and passes without causing any serious problems, particularly in children.

But sometimes complications can occur.

These are more common in:

  • pregnant women
  • adults, especially those who smoke
  • newborn babies under four weeks old
  • people with a weakened immune system (the body's defence system), such as people with HIV, those taking high doses of steroid medication and those having chemotherapy

Some of the main risks associated with chickenpox are outlined below.

Skin infections

The most common complication of chickenpox is the skin becoming infected with bacteria. This is more likely to happen if you or your child scratches your spots.

The skin may be infected if it becomes:

  • red
  • swollen
  • painful and tender

Contact your GP if you think your or your child's blisters have become infected. You may need antibiotics to treat the infection.

Lung infections

Occasionally, the chickenpox virus can spread to the lungs and cause pneumonia.

This is more common in adults (particularly those who smoke), pregnant women and people with weakened immune systems.

Symptoms of pneumonia can include:

Contact your GP as soon as possible if you think you or your child may have developed pneumonia. You may need to be treated in hospital.

Infections of the brain or nerves

In rare cases, chickenpox can lead to more serious infections of the brain and spinal cord in children, people with weakened immune systems and pregnant women.

This can cause:

  • a lack of energy
  • drowsiness
  • confusion
  • seizures (fits)
  • vomiting
  • severe headaches
  • stiff neck
  • behavioural changes
  • problems with walking, balance or speech

Seek medical advice as soon as possible if you or your child develops any of these symptoms after having chickenpox. Treatment in hospital will usually be needed.

Pregnancy problems

If you become infected with chickenpox for the first time while you're pregnant, there is a small risk of potentially serious complications affecting your baby.

The risks depend on when you pick up the infection.

  • Infection during the first 28 weeks can result in a rare but serious condition called congenital varicella syndrome, which may cause shortened limbs, vision problems (such as cataracts), brain damage and scarring.
  • Infection during weeks 28 to 37 can mean your baby is at risk of developing shingles at some point after they're born.
  • Infection a week before to a week after birth can mean your baby is a risk of a severe and potentially life-threatening chickenpox infection.

Contact your GP as soon as possible if you're pregnant or have given birth recently and you think you have chickenpox or have been exposed to someone with the infection.

Your GP can do a blood test to check if you're already immune to the infection and can arrange for you to have stronger treatments to prevent a severe infection.

Prevention

Prevention

Chickenpox is highly contagious and can make some people very ill, so it's important to try to avoid spreading it to others.

Some of the things you can do are outlined below.

Stay away from school or work

If you or your child has chickenpox, stay away from nursery, school or work until all of the blisters have dried up and scabbed over.

This usually happens five or six days after the rash first appears.

You may continue to have spots on your skin for another week or two, but you're no longer contagious if the spots are dry and scabby.

Avoid contact with people at risk

Certain people are at a higher risk of becoming seriously ill if they become infected with chickenpox.

These include:

  • pregnant women
  • newborn babies
  • people with a weakened immune system (the body's defence system), such as people with HIV, those taking high doses of steroid medication and those having chemotherapy

If possible, try to avoid contact with people from these groups until the blisters have scabbed over and you're no longer contagious.

Clean and wash regularly

Chickenpox can be spread through contact with objects that have been contaminated with the virus, such as toys, bedding or clothing.

If someone in your house has chickenpox, you can help stop it spreading by cleaning any objects or surfaces with a disinfectant and making sure that any infected clothing or bedding is washed regularly.

Check before travelling on a plane

If you or your child has chickenpox, you may not be allowed to fly until all the blisters have dried and scabbed over.

It's a good idea to inform the airline of your situation and check whether they have a policy about when they allow people with chickenpox to fly.

It's also important to let your travel insurer know if you or your child has chickenpox.

You need to make sure that you'll be covered if you have to delay or cancel your holiday, or if you need to extend your stay until your child is well enough to fly home.

Chemotherapy
Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.