Chickenpox: symptoms, causes & treatment

Chickenpox is an infectious disease caused by the varicella-zoster virus, a member of the herpes virus family. This virus is highly contagious and spreads very quickly, especially in the winter months and early spring. Almost everyone gets chickenpox as a child, which makes it a typical childhood illness that most people only experience once in a lifetime.

The disease mainly appears on your skin in the form of small, itchy blisters that gradually appear all over your body. What makes chickenpox special is that you can see different stages at the same time: new red bumps next to fresh blisters and dried scabs. This mix of injuries in different developmental phases is characteristic of the disorder.

The varicella-zoster virus has a remarkable feature: after a windpox infection, the virus does not disappear completely from your body. It withdraws into nerve cells where it can remain dormant for years. Later in life, often with weakened immune systems or increasing age, this virus can become active again and cause zona, a condition you may know as shingles.

For most healthy children, chickenpox passes without major problems and heals completely within a week and a half. The disease leads to lifelong protection against a new windpox infection. This natural immunity is highly effective, although the virus is therefore able to return in a different form later.

The spread of the varicella-zoster virus occurs in two main ways. First, via tiny droplets that float in the air when an infected person coughs, sneezes, or talks. This airborne transmission makes the virus so contagious that you can even become infected without direct contact with the sick person. A short meeting in a closed space may be sufficient.

Secondly, the virus can be transmitted through direct contact with the moisture in the skin blisters. This fluid contains large amounts of virus particles. Touching the blisters or contact with objects that are contaminated with this moisture can lead to contamination. This explains why it's so important for children with chickenpox to stay home.

The timing of contagiousness is crucial to understand. You are contagious even before you even know you are sick, one to two days before the first blisters appear. This early contagiousness makes it difficult to prevent the spread. You remain contagious until all blisters have dried and formed a scab, which lasts at least five days after the first rash appears.

After infection, it takes an average of two to three weeks before you become ill. This incubation period can range from ten to twenty-one days. During this period, the virus multiplies in your body without you noticing anything. You still feel healthy and just go about your business, while the virus quietly prepares for its attack.

Certain factors increase the risk of serious complications. A weakened immune system due to illness or medication makes you extra vulnerable. Pregnant women who have never had chickenpox are at risk of complications for themselves and their unborn child. Newborn babies have not yet built up their own defenses and are therefore particularly vulnerable. Adults who did not have the disease as children can also become more seriously ill than children.

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The symptoms of chickenpox develop in a characteristic pattern that usually makes the disease easily identifiable. It often starts with general complaints: you feel tired and lifeless. Children can become irritable and have less desire to eat. Within a day, the typical rash that confirms the diagnosis will follow.

Your skin first turns red in various areas, as if small insect bites appear. These red spots feel warm and may be slightly raised. Within hours, these bumps transform into clear blisters filled with liquid. These blisters are usually small, about the size of a pinhead, and are tensed on the underlying skin.

The itching associated with chickenpox can be intense and is the most bothersome aspect of the disease for many children. This itch comes in waves and often gets worse in the evening or night. The desire to scratch is almost irresistible, but scratching increases the risk of scarring and bacterial infections.

Fever often occurs early in the disease. The temperature can reach 38 or 39 degrees, sometimes even higher. This fever usually lasts a few days and often subsides before all the blisters have appeared. Some children barely have a fever, while others are quite ill.

The blisters follow a predictable course. After about a day, they burst open and deflate. Then the drying process begins, where scabs form. These scabs fall off on their own after about a week. What makes chickenpox unique is that you see blisters in different stages at the same time: fresh, cracked and dried ones side by side.

The rash usually starts on the torso and then spreads to the face, arms, and legs. You can get literally hundreds of blisters, although the number varies greatly from person to person. Some children have only a few dozen blisters, while others are covered with them. Sore blisters can also occur in the mouth, which makes eating and drinking unpleasant.

The distribution of windpox blisters across the body follows a typical pattern, although there are individual variations. The torso is almost always the epicenter of the rash. You usually see the highest concentration of blisters on your stomach, back and chest. This central part of your body is the first to be affected and often has the most injuries.

Your face is another major target for the virus. Blisters on your forehead, cheeks, and around your nose are very common. These visible injuries can be socially taxing, especially for older children who are aware of their appearance. Fortunately, these blisters also usually heal without permanent scars, unless scratched.

The arms and legs are also affected, although often to a lesser extent than the torso. The outside of the limbs usually has more blisters than the inside. Hands and feet may also be affected, including the palms and soles, although this is less common.

The hairy scalp is a location that is often forgotten but is regularly involved. Blisters between the hair can cause extra itching and are more difficult to care for. After healing, these areas may be temporarily bare, but the hair will simply grow back.

Particularly annoying are the blisters that develop on mucous membranes. In the mouth, they can occur on the inside of the cheeks, the palate, and the tongue. These mouth injuries are painful and make eating and drinking unpleasant. Vesicles can also form in the genital region, which makes urination uncomfortable.

It is remarkable that some parts of the body are relatively spared. The palms and soles often have remarkably few blisters compared to the rest of the body. This is due to the thicker skin structure in these areas, which is less easy for the virus to enter.

The treatment of chickenpox focuses primarily on alleviating symptoms and preventing complications. Healthy children often do not require specific medical treatment, as the body overcomes the virus itself. The focus is on comfort and reducing discomfort during the healing process.

Fever reduction is an important part of symptomatic treatment. Paracetamol painkillers are the first choice for lowering fever and reducing general unwell. These drugs are safe for children and effective in controlling fever. It's important to avoid certain other pain relievers because they can increase the risk of skin complications.

Controlling itching is essential to prevent scratching. Antihistamines in the form of tablets or drops can significantly reduce itching. These drugs make some children a little sleepy, which can actually be beneficial because it promotes rest. For local relief, cooling lotions or creams can be used that have a calming effect on irritated skin.

Bathing plays an important role in care. Lukewarm baths with any additives that soothe the itching provide temporary relief. It is important to gently pat the skin dry afterwards instead of rubbing it. Bathing too frequent or too long, however, can make the skin extra dry and make itching worse, so moderation is important.

Antiviral medications exist for the small group of patients with an increased risk of complications. This treatment is only effective when started within 24 hours of the first vesicles appearing. It inhibits the multiplication of the virus and can significantly mitigate the disease. As standard, this medication is given to people with weakened immune systems, pregnant women and children over the age of 12 with certain risk factors.

When a bacterial infection develops on top of the chickenpox, antibiotic treatment is necessary. Signs of this include increasing redness around the blisters, suppuration, renewed fever after a period of improvement, or increasing pain. These secondary infections can be serious and often require prompt medical attention.

Preventive measures exist for people who have been in close contact with chickenpox but are themselves at increased risk. Vaccination within three days of exposure can prevent or significantly mitigate the disease. People with a highly weakened immune system can be given antibodies that offer immediate protection.

There are several misconceptions about treating chickenpox that are better avoided. The use of certain anti-inflammatory pain relievers is not advisable, although they appear effective for fever and pain. These agents may increase the risk of serious skin infections and cause other complications. Paracetamol remains the safest choice.

The idea that you should “get rid of” chickenpox without any symptom relief is outdated and unnecessary. There is no reason to let a child suffer unnecessarily from fever and itching when safe remedies are available to alleviate these symptoms. Comfort promotes recovery and prevents complications from scratching.

Home remedies such as applying toothpaste, vinegar, or other household products to the blisters are not effective and may even be harmful. These substances irritate the already inflamed skin even more and can delay healing. Medically approved creams and lotions are a much better choice.

Intentionally exposing children to chickenpox to build immunity, called “chicken pox parties,” is not a wise practice. Although it is true that chickenpox is usually milder at a young age, there is always a risk of complications. With the availability of safe vaccinations, this risky approach is no longer necessary.

The idea that you can just go to school or daycare with chickenpox when the fever is gone is also wrong. You are contagious as long as all blisters have not dried up. Early return to community settings spreads the disease unnecessarily and puts vulnerable people at risk.

How long does my child have to stay home?

Your child can go back to school or daycare when all the blisters have dried and crusted. This takes at least six days after the first blisters appear, but may be longer. As long as there are still fresh blisters, your child is contagious and should stay home.

Can adults get chickenpox?

Yes, adults who did not experience the disease as children can get chickenpox. In adults, the disease is often more severe than in children, with more blisters, higher fever and a greater risk of complications such as pneumonia. Therefore, vaccination for non-immune adults is definitely worth considering.

Will there be any scars left?

In most children, the blisters heal without permanent scarring, provided they are not scratched. Scratching damages the deeper layers of the skin and can leave permanent pitting. This is the main reason to treat the itch properly and cut the nails short.

Can my child get chickenpox twice?

This is extremely rare. Immunity after a windpox infection is almost always lifelong. In very exceptional cases, for example in people with severely weakened immune systems, a second infection may occur, but this is really highly unusual.

What is the difference between chickenpox and zona?

Both conditions are caused by the same virus. Chickenpox is the first infection, usually in childhood. Zona occurs when the dormant virus becomes active again later in life. Zona gives a painful rash that is limited to one part of the body and follows the course of a nerve.

Is vaccination against chickenpox wise?

Although the chickenpox vaccine is not given as standard in the basic vaccination program, it can be administered to children from the age of 12 months on request. It is particularly important for people at increased risk of complications and for non-immune adults who come into contact with vulnerable groups.

1. Health and Science: Chickenpox or Chicken Pox
   
2. BEPnet: Varicella (chicken pox, chicken pox)
   
3. Child and Family: Chickenpox
   
4. Home doctor: Chicken pox