What causes it?

Varicella is found worldwide and is most common in children during the late winter and spring. It is highly contagious both by direct contact and through respiratory secretions, especially in the few days before the rash appears and just afterward. The VZV vaccine has dramatically decreased the incidence of the disease.   

What does it look like?

After an incubation period of 10-14 days, the patient often has mild headache, fever, and malaise for about 24 to 36 hours before the rash appears. The rash begins with red spots that soon turn to fluid-filled blisters. The bumps are said to look like a “dew drops on a rose petal” because the fluid-filled blister sits on a background of erythema. The rash usually begins on the scalp, face, or trunk and spreads to the extremities, but generally spares hands and feet. New spots continue to appear for 3-6 days. Old blisters crust over at the same time as new ones appear so the patient often has a mix of old and new lesions even in the same area of skin – the presence of lesions in multiple stages of development is a hallmark of this disease. 

Is it dangerous?

For most children, chicken pox is an itchy, annoying sickness that has no complications. For some children – and more commonly for teenagers and adults – it can be dangerous. The complications of chicken pox are development of pneumonia, neurologic involvement, orchitis, and secondary infection with bacteria. Another concern is that it can affect a developing baby, so pregnant women should avoid contact with people who have the chicken pox. Also, once the spots are scratched open, they can become infected especially with Staphylococcal or Streptococcal species.  

How is it treated?

For uncomplicated cases, the treatment is supportive: calamine, oatmeal baths, and antihistamines can help to minimize the itching down. Antipyretics can help with fevers. Topical antibiotics (e.g. mupirocin or bacitracin) on any scratched bumps can keep them from getting infected. For severe or complicated cases, or in immunocompromised patients, the treatment is with acyclovir.  Patients should not return to school or to work until all of the lesions have crusted over.

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