chickenpox

Chickenpox, or varicella, is one of those childhood viral diseases that we used to hope everybody would catch in childhood (before we had the vaccine). That's because the illness can be much more severe for adults and can entail more complications. In fact, chickenpox in an adult can lead to hospitalization or worse.

Chickenpox is highly contagious. Kids who spend one hour in a room with a playmate actively shedding the varicella virus have about a 95% chance of developing the disease. The incubation period after exposure is 10 to 21 days, averaging about 12 days.

There may be fever, although often there isn't much if any temperature elevation. The rash that appears is unmistakable: tiny red dots appear which rapidly develop clear little blisters (vesicles) atop them. The blisters enlarge, maybe an eighth of an inch or so in diameter, and then rupture. The lesions will be spread over the entire body surface (key point - not just in one place) but may be worse in warm areas such as the diaper area (I can remember how awful my fourth boy's diaper area looked when he had them as a toddler). The lesions may also appear in the throat or in the vagina of little girls. The lesions on the skin itch like crazy after a day or so.

Treatment of chickenpox is basically symptom relief and the prevention of infection of the lesions. If the blisters don't get infected they tend to scar less if at all. Since you child will feel a lot better in a cool oatmeal (Aveeno®) or baking soda bath, this takes care of itself to some degree. Keep the child's fingernails short. You may use various anti-itching agents on the skin - Caladryl®, Sarna® or a host of others - whatever your doctor usually recommends. Nothing is really great. Don't put Benadryl® cream or benzocaine sprays on chickenpox because kids can become sensitized to them and have a reaction. And don't put hydrocortisone cream on chickenpox - it is an immune suppressant and could make things worse.

Varicella lesions sometimes get infected with more than the usual grungy Staph and Strep germs that hang out on the skin. The sores can get infected with the Group A Strep germ that causes strep throat, rheumatic fever, etc. If a chickenpox sore shows signs of cellulitis - spreading redness around the sore that looks different from the other lesions on the body - better call your doctor. If your child develops a second rash - red, rough, sandpapery feeling - especially in the diaper/underpants area - that could be scarletina caused by Group A Strep. Call your doctor right away.

Your child will be contagious for two days BEFORE she breaks out and five days thereafter. I generally send them back to school on the day of the week they broke out.

As mentioned above, there is a vaccine, Varivax®, available to prevent chickenpox. It is recommended by the CDC (Centers for Disease Control) for all children over one year of age. The vaccine has proven to be extremely safe. If you personally think you have never had chickenpox, you´d better get on down to your doctor, get tested for immunity (many people are immune who swear they never had varicella) and if you're susceptible, get the shot. For adults, it sure beats the hospital. Because of waning immunity over time and breakthrough cases, we now give a booster dose at five years old.

Don't ask why it's called chickenpox. I have no idea.

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