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Chicken Pox treatment

Chickenpox and shingles are both caused by the same virus, called “VZV.” Chickenpox is the illness children get the first time they have an infection with VZV. Chickenpox usually starts out like any other viral illness, with a little fever, a runny nose, and sometimes a cough. Within about 3 days, children develop the classical “pox.” The pox can appear anywhere on the body or in the mouth, nose, or linings of the eyelids. They are small blisters filled with clear fluid, and the skin around them is red. They are very itchy – it can be hard to keep younger children from scratching them. Sores in the mouth and throat can make it hard for the child to eat or drink. The fever is usually highest when the pox break out. The pox continue to break out in “crops” for 2-3 days, and then they begin to crust over. Children continue to spread the virus until the last pox are crusted over, usually a week to ten days after the first outbreak.

Shingles are pox that break out in people who have had chickenpox in the past. The virus continues to live in nerve cells, and with increasing age, or a drop in immunity, it can break out again. The pox in shingles break out in the patterns of the nerves that are infected, often in a band-like pattern on one part of the body only. People with shingles often complain of intense pain, burning, or tingling of their skin in the area for a day or two before the pox break out. The pox are itchy or painful, and the child may have fever or a generally ill feeling. Shingles go away in about three weeks, but some medications may help to speed that up.

Chickenpox vaccine has been available in the United States since 1995. This has made the disease much less common. The vaccine prevents chickenpox in 85 – 90% of children who get it. This means that there are still a number of children who get chickenpox every year. A very tiny number of children may develop shingles as a result of the vaccine, but this is very rare.

What is the biggest concern with Chicken Pox?

Parents’ first concern with chickenpox is usually the itching, fever, and general “miserableness” of their child. Fortunately, we can take care of most of these with a few simple treatments and avoiding a few others. Many parents and older children worry about scars from the pox, especially on the face. Pox do not generally cause scars unless they get infected with bacteria. This usually occurs when the child scratches or picks at the pox. A very small number of children with chickenpox develop serious complications such as widespread infection, pneumonia, dangerous strep infections of the skin, and brain or nervous system illnesses. We can prevent most of these from occurring or getting worse by paying careful attention to the child.

The biggest immediate concern in shingles is pain. The other concern is to be sure we know why a child got shingles. Shingles does happen in healthy children, but it is quite rare. Children who are taking medications or have conditions that weaken their immune system get shingles more commonly. If your child got shingles, and is not taking any medicine that could weaken his or her immune system, please check with your doctor right away about testing for any condition that might cause shingles.

Chicken Pox treatment

For both chickenpox and shingles, you can use acetaminophen (Tylenol® and others) or ibuprofen (Advil® or Motrin® and others) to control fever and discomfort. Fever is not dangerous, but it can make your child uncomfortable. If your child seems comfortable there is no reason to give any medication just for fever. Do not give aspirin or any medication that contains aspirin or “salicylate.” During chickenpox, these can cause a dangerous condition called “Reye Syndrome.”

You can give your child diphenhydramine (dye-fen-hi-drah-meen; Benadryl® and many others) for itching.

The main side effect of diphenhydramine is drowsiness, which is actually often helpful to a child whose itching is making him or her frantic. Diphenhydramine in topical lotions does not help itching more than the lotion itself. You can read our Aftercare Instruction on Oral Medications..

Other comfort measures you can use include bathing your child in a warm bath with a cup or two of uncooked oatmeal added (You’ll want to put a strainer in the drain to prevent clogging!). This soothes the skin and reduces the itching. You can buy a commercial version of this, called “Aveeno Bath®,” which is a lot easier to clean up.

Try to prevent your child from scratching or picking at the pox, to prevent infection. Your doctor may recommend using an antibiotic ointment such as bacitracin or polysporin if any of the sores seem to be getting infected.

If your child is taking steroids, or has a condition that might weaken his or her immune system, your doctor might prescribe an antiviral drug such as acyclovir (Zovirax®). Doctors usually do not use this drug to treat chickenpox in children who are otherwise healthy, unless there are special circumstances, like another person in the household who has an immune system problem.

In shingles, pain control is usually the most important concern. Your child is likely to need medicine stronger than the over-the-counter drugs. Please do not hesitate to ask your doctor for a prescription pain medicine if you believe that your child is in pain. These medicines are safe when used as directed, and do not cause addiction when they are treating pain.

We do treat shingles with antiviral drugs such as acyclovir. The earlier we can catch the outbreak, the more effective is the treatment. The first time your child got shingles it was probably not diagnosed until after the pox broke out. Since shingles can happen repeatedly, you and your child should try to learn the signs of an upcoming outbreak, like burning, pain, or itching in the area. The antiviral medicines are most effective if you give them as soon as any signs appear.

When should I be worried?

Most children with chickenpox get better with time and comfort measures. Complications of chickenpox are rare but possibly serious. If your child has:

  • Redness or pain that spreads rapidly away from the site of a pox sore
  • Redness larger than the size of a US quarter around any one pock
  • Rapidly spreading redness or swelling between the pox
  • Pain in the skin or area between the pox, or pain with movement of an arm or leg where there are pox
  • Dark purple or black areas at the centers of the pox, or of the skin surrounding them
  • Large blisters
  • High fever (over 102.5 ° F or 39 ° C)

These may be signs of serious infection or necrotizing fasciitis (neck-roh-tize-ing fash-ee-eye-tis, or “flesh-eating strep”). Call your doctor or go to the emergency room right away.

If your child has:

  • Lethargy (sleepiness) or irritability
  • Trembling or tremors
  • Dizziness
  • Stumbling or a widespread stance when walking
  • Bizarre behavior or hallucinations

These are signs of encephalitis (en-seff-a-lite-iss), cerebellitis (ser-a-bell-eye-tiss) (brain inflammation), or Reye Syndrome. Call your doctor or go to the emergency room right away.

If your child develops:

  • Fever lasting more than 2-3 days after the first rash appears
  • Cough
  • Wheezing
  • Difficulty breathing

These could be signs of pneumonia or other serious bacterial infection. Please call your doctor immediately.




Other possible complications of chickenpox include:

ITP – in this condition the child develops antibodies against his or her platelets, the tiny cells that help blood to clot. When ITP happens, it begins a few days to a few weeks after the pox heal. Tiny red spots that do not blanch or turn pale if you press on them are the first signs of ITP. Some children get bruises easily as well. ITP is easily treatable and usually does not happen more than once. It can cause dangerous bleeding if not treated though, so please call your doctor right away if your child develops those tiny red spots.

“Bullous” chickenpox or shingles: these are large blisters that can form in addition to, or instead of, the usual tiny pox sores. They can look like burns. Certain bacteria are often found inside the blisters, so your doctor should see them to decide if you should use antibiotics.
“Bell’s Palsy” – a temporary weakness or paralysis of one side of the face. This is caused by re-activation of the VZV virus just like shingles, but there is often no shingles rash.

Because children with chickenpox or shingles can spread the live virus to others, please keep your child home until all of the sores are crusted over. Keep your child away from pregnant women, and from people whose immune systems might be weakened. This includes people with cancer, on treatment with steroids, or people with immune deficiency diseases like HIV/AIDS. It also includes young infants. Chickenpox can be devastating to those people.

Other Conditions that Might Be Present

A few uncommon diseases can look like chickenpox. The most deadly is smallpox, which does not exist in the world except in laboratories. There have been fears of a terrorist attack using smallpox virus, however. Smallpox starts with a high fever and often a headache. People with smallpox go on to develop large numbers of small, perfectly round blisters on red bases. Smallpox blisters are often cloudy on the inside. People with smallpox appear much sicker than people with chickenpox. Unlike chickenpox, the pox in smallpox appear all at once, not in “crops.”

In 2003 a small number of people in the Midwest USA developed an infection called “monkey-pox,” which before then had been restricted mainly to animals in Africa. The people in the US who got monkey-pox all had been exposed to prairie dogs or giant Gambian rats which came from pet stores. There have not been any other cases in the United States, but if your child has been exposed to rodents, especially unusual ones, please let your doctor know.

An unusual form of the common skin infection, impetigo, can sometimes look a little like chickenpox. This is called “bullous impetigo,” and consists of medium to large blisters over red skin, in only very isolated parts of the body. Children with bullous impetigo generally don’t have fever, and usually have had broken, irritated skin for a day or two before the blisters develop. We treat bullous impetigo with antibiotics.

Insect bites like mosquito and gnat bites sometimes get infected and blisters may form. We treat these just as we do bullous impetigo, with antibiotics.