How to identify and treat chickenpox

Chickenpox is a common illness caused by the varicella-zoster virus. While it is often associated with children, adults can also catch it, sometimes with more severe complications. Here, we look at what it is, how to identify chickenpox on different skin tones, treatment, and when to consult a doctor.

What is chickenpox?

Chickenpox is a highly contagious viral infection characterised by a distinct itchy rash. It spreads through direct contact with anyone who is infected, or through the air via coughs and sneezes. While it’s usually mild, certain groups of people may experience more serious symptoms.

Who is likely to catch chickenpox?

Chickenpox is particularly common in:

1. Children under 10 years old: Most cases occur in this age group, and for many, it’s a mild illness.
2. Teenagers and adults: These age groups may experience more severe symptoms compared to children.
3. Pregnant women: Chickenpox during pregnancy can pose risks to both the mother and the baby.
4. Immunocompromised people: This includes anyone with a weakened immune system, such as those undergoing chemotherapy, or living with conditions such as MS or HIV/AIDS.

Signs and symptoms of chickenpox

Chickenpox typically progresses through three stages, and symptoms include:

1. Initial symptoms (1–2 days before the rash):
   • Fever
   • Tiredness and irritability
   • Loss of appetite
   • Headache
2. The rash (main symptom):
   • Small, red spots appear on the body, often starting on the chest, back, and face before spreading (see below for details on how to identify the rash on different skin tones)
   • These spots develop into fluid-filled blisters
   • The blisters eventually dry out and form scabs, which fall off naturally
3. Itchy skin:
   • Itching can be severe and uncomfortable, posing a risk of infection if the blisters are scratched.

Chickenpox appears differently on varying skin tones, which can affect its visibility and how it’s identified. Here’s how it typically presents:

Chickenpox on paler skin:

• Colour: The rash starts as small red spots that develop into itchy, fluid-filled blisters. These blisters can later crust over into scabs.
• Visibility: The redness is more pronounced against light skin, making the spots easier to notice in the early stages.
• Progression: The colour of the blisters may appear bright red initially and then fade as they scab over.

Chickenpox on Brown skin:

• Colour: The spots may appear less red and more pink or darker than the surrounding skin, depending on the person’s undertone.
• Visibility: The redness might not be as striking, so the blisters’ fluid-filled appearance is more critical for identification.
• Progression: Scabbing might leave temporary hyperpigmentation (darker spots) as they heal.

Chickenpox on Black skin:

• Colour: The initial spots may appear dark brown or purplish rather than red. The blisters can look slightly lighter or shinier than the surrounding skin when filled with fluid.
• Visibility: Redness is generally subtle or absent, so swelling, blistering, and texture changes are key signs.
• Progression: Healing often results in hyperpigmented scars or marks that may take longer to fade.

Challenges in identification:

• On darker skin tones, the subtle colour differences might delay recognition. Identifying the fluid-filled blisters and associated symptoms can help.
• On all skin tones, the distribution (usually starting on the torso and spreading) and pattern of the rash are helpful diagnostic clues.

Symptoms usually appear 10 – 21 days after exposure to the virus.

How to treat chickenpox

Chickenpox treatment focuses on managing symptoms, as the virus usually resolves on its own within a week to 10 days. NHS guidelines recommend the following:

1. Easing discomfort:

• Use paracetamol for fever or pain. Avoid ibuprofen unless advised by a doctor, as it can increase the risk of serious skin infections.
• Apply cooling creams or gels, such as calamine lotion, to soothe itching.
• Wear loose-fitting, soft clothing to reduce irritation.
• Keep fingernails short to minimise the risk of scratching and infecting the blisters.

2. Hydration and rest:

• Drink plenty of fluids to stay hydrated.
• Rest as much as possible to help the immune system fight the virus.

3. Antihistamines:

• Over-the-counter antihistamines may help relieve itching, especially at night.

What not to do when you have chickenpox

Ensure you avoid:

1. Scratching blisters: This increases the risk of infection and scarring.
2. Using aspirin: Aspirin is linked to a rare but serious condition called Reye’s syndrome in children with viral illnesses.
3. Close contact with vulnerable groups: Avoid contact with pregnant women, newborn babies, and those with weakened immune systems until the rash has completely scabbed over.
4. Going to school or work: Stay at home until all the spots have crusted over, which usually happens around day five.

When should you visit a GP?

While chickenpox is often mild, there are situations where medical advice is essential:

1. Severe symptoms:
   • If the spots become red, swollen, and painful, indicating a possible bacterial infection.
   • Difficulty breathing or severe dehydration.
2. Vulnerable people:
   • Pregnant women or people with weakened immune systems who have been exposed to chickenpox.
3. Newborns with symptoms:
   • If a baby under four weeks old shows signs of chickenpox, consult a GP immediately.
4. Prolonged illness:
   • If symptoms worsen or don’t improve after 10 days.
5. Exposure during pregnancy:
   • Chickenpox during pregnancy requires immediate medical attention due to potential risks to the unborn baby.

 

Chickenpox is usually a mild illness, but it can lead to complications in certain people. Knowing how to manage symptoms and when to seek medical advice is essential for a smooth recovery. Always follow NHS recommendations, and if in doubt, contact your GP for guidance.