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The spots normally appear in clusters and tend to be:

  • behind the ears

  • on the face

  • over the scalp

  • on the chest and belly

  • on the arms and legs

but, the spots can be anywhere on the body, including:

  • inside the ears and mouth

  • on the palms of the hands

  • soles of the feet

  • inside the nappy area.

Some children and adults are at special risk of serious problems if they catch chickenpox. They include:

  • pregnant women

  • newborn babies

  • people with a weakened immune system

These people should speak to their GP as soon as they are exposed to the chickenpox virus or they develop chickenpox symptoms.

They may need a blood test to check if they are protected from (immune to) chickenpox.

The rash starts as small, itchy red spots. These develop a blister on top and become very itchy after about 12 to 14 hours.

After a day or two, the fluid in the blisters gets cloudy and they begin to dry out and crust over.

After 1 to 2 weeks, the crusting skin will fall off naturally.

New spots can keep appearing in waves for 3 to 5 days after the rash begins. So, different groups of spots may be at different stages of blistering or drying out.

Chickenpox is highly contagious to those who have not had the disease or been vaccinated against it.

The diagnosis of chickenpox is primarily based on the signs and symptoms, with typical early symptoms followed by a characteristic rash.

The most characteristic symptom is an itchy, blister-like rash on the skin.

Chickenpox can be prevented by a vaccine. Treatment usually involves relieving symptoms, although high-risk groups may receive antiviral medications.

Some people who have been vaccinated against chickenpox can still get the disease,

called breakthrough chickenpox. However, they usually have milder symptoms with fewer or no blisters (or just red spots), a mild or no fever, and are sick for a shorter period than people who are not vaccinated.

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.

The spread of chickenpox can be prevented by isolating affected individuals. Contagion is by exposure to respiratory droplets, or direct contact with lesions, within a period lasting from three days before the onset of the rash, to four days after the onset of the rash. The chickenpox virus is susceptible to disinfectants, notably chlorine bleach (i.e., sodium hypochlorite). Like all enveloped viruses, it is sensitive to drying, heat and detergents.

Treatment mainly consists of easing the symptoms. As a protective measure, people are usually required to stay at home while they are infectious to avoid spreading the disease to others. Cutting the fingernails short or wearing gloves may prevent scratching and minimize the risk of secondary infections.

Although there have been no formal clinical studies evaluating the effectiveness of topical application of calamine lotion (a topical barrier preparation containing zinc oxide, and one of the most commonly used interventions), it has an excellent safety profile. Maintaining good hygiene and daily cleaning of skin with warm water can help to avoid secondary bacterial infection; scratching may increase the risk of secondary infection.

Paracetamol (acetaminophen) but not aspirin may be used to reduce fever. Aspirin use by someone with chickenpox may cause serious, sometimes fatal disease of the liver and brain, Reye syndrome. People at risk of developing severe complications who have had significant exposure to the virus may be given intra-muscular varicella zoster immune globulin (VZIG), a preparation containing high titers of antibodies to varicella zoster virus, to ward off the disease

The duration of the visible blistering caused by varicella zoster virus varies in children usually from 4 to 7 days, and the appearance of new blisters begins to subside after the fifth day. Chickenpox infection is milder in young children, and symptomatic treatment, with sodium bicarbonate baths or antihistamine medication may ease itching.

In adults, ‘the disease is more severe’, though the incidence is much less common. Infection in adults is associated with greater morbidity and mortality due to pneumonia (either direct viral pneumonia or secondary bacterial pneumonia), bronchitis (either viral bronchitis or secondary bacterial bronchitis), hepatitis, and encephalitis. In particular, up to 10% of pregnant women with chickenpox develop pneumonia, the severity of which increases with onset later in gestation.

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