It’s very rare to have the chickenpox infection more than once. And since the chickenpox vaccine was introduced in the mid-1990s, cases have declined.
An itchy rash is the most common symptom of chickenpox. The infection will have to be in your body for around seven to 21 days before the rash and other symptoms develop. You start to be contagious to those around you up to 48 hours before the skin rash starts to occur.
The non-rash symptoms may last a few days and include:
fever
headache
loss of appetite
One or two days after you experience these symptoms, the classic rash will begin to develop. The rash goes through three phases before you recover. These include:
You develop red or pink bumps all over your body.
The bumps become blisters filled with fluid that leaks.
The bumps become crusty, scab over, and begin to heal.
The bumps on your body will not all be in the same phase at the same time. New bumps will continuously appear throughout your infection. The rash may be very itchy, especially before it scabs over with a crust.
You are still contagious until all the blisters on your body have scabbed over. The crusty scabbed areas eventually fall off. It takes seven to 14 days to disappear completely.
The early (prodromal) symptoms in adolescents and adults are nausea, loss of appetite, aching muscles, and headache. This is followed by the characteristic rash or oral sores, malaise, and a low-grade fever that signal the presence of the disease. Oral manifestations of the disease (enanthem) not uncommonly may precede the external rash (exanthem). In children the illness is not usually preceded by prodromal symptoms, and the first sign is the rash or the spots in the oral cavity. The rash begins as small red dots on the face, scalp, torso, upper arms and legs; progressing over 10–12 hours to small bumps, blisters and pustules; followed by umbilication and the formation of scabs. At the blister stage, intense itching is usually present. Blisters may also occur on the palms, soles, and genital area. Commonly, visible evidence of the disease develops in the oral cavity and tonsil areas in the form of small ulcers which can be painful or itchy or both; this enanthem (internal rash) can precede the exanthem (external rash) by 1 to 3 days or can be concurrent. These symptoms of chickenpox appear 10 to 21 days after exposure to a contagious person. Adults may have a more widespread rash and longer fever, and they are more likely to experience complications, such as varicella pneumonia. Because watery nasal discharge containing live virus usually precedes both exanthem (external rash) and enanthem (oral ulcers) by 1 to 2 days, the infected person actually becomes contagious one to two days before recognition of the disease. Contagiousness persists until all vesicular lesions have become dry crusts (scabs), which usually entails four or five days, by which time nasal shedding of live virus ceases.
The condition usually resolves by itself within a couple of weeks. The rash may, however, last for up to one month. Chickenpox is contagious starting from one to two days before the appearance of the rash and lasts until the lesions have crusted. Chickenpox is rarely fatal, although it is generally more severe in adult men than in women or children. Non-immune pregnant women and those with a suppressed immune system are at highest risk of serious complications. Arterial ischemic stroke (AIS) associated with chickenpox in the previous year accounts for nearly one third of childhood AIS. The most common late complication of chickenpox is shingles (herpes zoster), caused by reactivation of the varicella zoster virus decades after the initial, often childhood, chickenpox infection.
CAUSES
What causes chickenpox?
Varicella-zoster virus (VZV) causes the chickenpox infection. Most cases occur through contact with an infected person. The virus is contagious to those around you for one to two days before your blisters appear. VZV remains contagious until all blisters have crusted over. The virus can spread through:
saliva
coughing
sneezing
contact with fluid from the blisters
RISK FACTORS
Who is at risk of developing the chicken pox?
Exposure to the virus through previous active infection or vaccination reduces risk. Immunity from the virus can be passed on from a mother to her newborn. Immunity lasts about three months from birth.
Anyone who has not been exposed may contract the virus. Risk increases under any of these conditions:
You have had recent contact with an infected person.
You are under 12 years of age.
You are an adult living with children.
You have spent time in a school or child care facility.
Your immune system is compromised due to illness or medications.
DIAGNOSIS
How is chickenpox diagnosed?
You should always call your doctor any time you develop an unexplained rash, especially if it’s accompanied by cold symptoms or fever. One of several viruses or infections could be affecting you. Tell your doctor right away if you are pregnant and have been exposed to chickenpox.
You doctor may be able to diagnose chickenpox based on a physical exam of blisters on you or your child’s body. Or, lab tests can confirm the cause of the blisters.
COMPLICATIONS
What are possible complications of chickenpox?
Call your doctor right away if:
The rash spreads to your eyes.
The rash is very red, tender, and warm (signs of a secondary bacterial infection).
The rash is accompanied by dizziness or shortness of breath.
When complications occur, they most often affect:
infants
older adults
people with weak immune systems
pregnant women
These groups may also contract VZV pneumonia or bacterial infections of the skin, joints, or bones.
Women exposed during pregnancy may bear children with birth defects, including:
poor growth
small head size
eye problems
intellectual disabilities
TREATMENTS
How is chickenpox treated?
Most people diagnosed with chickenpox will be advised to manage their symptoms while they wait for the virus to pass through their system. Parents will be told to keep children out of school and day care to prevent spread of the virus. Infected adults will also need to stay home.
Your doctor may prescribe antihistamine medications or topical ointments, or you may purchase these over the counter to help relieve itching. You can also soothe itching skin by:
taking lukewarm baths
applying unscented lotion
wearing lightweight, soft clothing
Your doctor may prescribe antiviral drugs if you experience complications from the virus or are at risk for adverse effects. People at high risk are usually the young, older adults, or those who have underlying medical issues. These antiviral drugs do not cure chickenpox. They make the symptoms less severe by slowing down viral activity. This will allow your body’s immune system to heal faster.
OUTLOOK
What is the long-term outlook?
The body can resolve most cases of chickenpox on its own. People usually return to normal activities within one to two weeks of diagnosis.
Once chickenpox heals, most people become immune to the virus. It won’t be reactivated because VZV typically stays dormant in the body of a healthy person. In rare cases, it may re-emerge to cause another episode of chickenpox.
PREVENTION
How can chickenpox be prevented?
The chickenpox vaccine prevents chickenpox in 98 percent of people who receive the two recommended doses. Your child should get the shot when they are between 12 and 15 months of age. Children get a booster between 4 and 6 years of age.
Older children and adults who haven’t been vaccinated or exposed may receive catch-up doses of the vaccine. As chickenpox tends to be more severe in older adults, people who haven’t been vaccinated may opt to get the shots later.
People unable to receive the vaccine can try to avoid the virus by limiting contact with infected people. But this can be difficult. Chickenpox can’t be identified by its blisters until it has already been spreadable to others for days.
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