Chickenpox is a very contagious infection caused by the varicella zoster virus, spread through the air and by contact with blisters. It is now uncommon in the United States thanks to vaccination, and it is usually mild in children but more severe in adults, pregnant women and people with weak immunity.
Key symptoms
- Fever, tiredness and poor appetite 1 to 2 days before the rash
- Itchy rash that starts on the face and trunk and spreads
- Spots go from red bumps to blisters to crusts
- New crops of spots for several days
- Contact with chickenpox or shingles 10 to 21 days earlier
What you find on exam
- Lesions in different stages at the same time
- Clear blisters on a red base
- Lesions in the mouth and on the scalp
- Signs of skin infection, lung or neurologic complications
Tests
- Usually a clinical diagnosis
- PCR from a blister when unsure or in high-risk patients
- Chest X-ray if cough or breathlessness
- Varicella IgG to check immunity in exposed high-risk contacts
Treatment basics
- Supportive care: acetaminophen for fever, antihistamines, oatmeal baths, short nails
- No aspirin in children because of Reye syndrome
- Oral acyclovir or valacyclovir within 24 hours for teens, adults and others at higher risk
- IV acyclovir for immunocompromised patients or complications
- Airborne and contact precautions; vaccine or varicella immune globulin after exposure
Red flags
- Cough, breathlessness or chest pain: varicella pneumonia
- Confusion, unsteady walking or seizures: brain involvement
- Red, hot, spreading skin around lesions or new high fever: bacterial infection
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; CDC, Guideline for Isolation Precautions (2007) and PPE sequence; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.