Chickenpox is one of those diseases that we don’t think about as much as we used to. It’s for good reason: The chickenpox vaccine, which was introduced in 1995, prevents 70-90% of infections and 95% of severe cases. Plus, it is included in the Centers for Disease Control and Prevention’s (CDC) recommended childhood immunization schedule.
Of course, those numbers don’t mean you’re guaranteed to avoid it. If you or your child are experiencing an itchy skin rash, you’ll need to learn the symptoms of chickenpox so you know when you might need to speak with a doctor. Here’s what to know about chickenpox, from its cause and symptoms to treatments and risk factors.
Chickenpox (varicella) is a viral, blister-laden skin rash
Chickenpox is a highly contagious viral infection. It is mostly known for its main symptom, which is an itchy skin rash with small, pimple-like blisters. It’s most common in kids under 10 years old, but anyone can catch it. A first-time case of chickenpox in adults and adolescents tends to be more serious than in children, possibly because of changes in the immune system as the body matures.
The cause of chickenpox and how it’s spread
Chickenpox is caused by the varicella-zoster virus, which is also responsible for shingles in adults. The virus can be spread through saliva, mucus or blister fluid. This means that you can be exposed to chickenpox through coughing, sneezing, direct contact with other people and contaminated objects. It’s uncommon to catch chickenpox after having had it once or getting vaccinated against it, but in the rare instance you do, the symptoms tend to be milder.
The relationship between chickenpox and shingles
Later in adulthood, people who have had chickenpox can develop shingles – a painful, blistery rash that typically appears on one side of the body. The varicella-zoster virus stays in the body after a chickenpox infection, and shingles occurs when the virus gets reactivated during a period of immune system weakness. The immune system can be weakened by factors like other infections, stress, poor sleep, alcohol consumption and smoking.
Someone with shingles can spread the varicella-zoster virus to others while the rash is present, but an infection will result in chickenpox, not shingles.
Just like with chickenpox, there is a vaccine available for shingles. It’s called Shingrix, and the CDC recommends it for people aged 50 and older, as well as people aged 19 and older who have weakened immune systems. Talk with your doctor if you have questions about the Shingrix vaccine.
How to recognize chickenpox symptoms: Early signs, normal characteristics and differences from other rashes
Chickenpox can generally be distinguished from other rash-causing conditions by the specific features of its rash and the other symptoms that usually appear with it. Again, if your immune system is already familiar with chickenpox from vaccination or a previous infection, symptoms are likely to be milder and some may even be absent.
Early symptoms of chickenpox
A couple of days before the chickenpox rash appears, you or your child may develop cold or flu-like symptoms. These can include:
- Fever
- Reduced appetite
- Headache
- Fatigue
- Coughing
- Sore throat
What the chickenpox rash looks like
The chickenpox rash is characterized by itchy, raised bumps that can look like pimples or bug bites. It typically starts on the face, scalp, chest or back before spreading across the entire body. The bumps gradually turn into blisters, which eventually burst and scab over. Generally, chickenpox doesn’t leave scars unless the rash is scratched, which can also cause a bacterial infection.
Other causes of skin rashes and how they differ from chickenpox
- Hand, foot and mouth disease (HFMD) – Flu-like symptoms and a skin rash are both main symptoms of HFMD, but as the name implies, the rash tends to appear primarily on the palms of the hands and the soles of the feet. However, it can also spread to other parts of the body including the face and buttocks.
- Impetigo – The most common type of impetigo, non-bullous impetigo, is another condition characterized by a skin rash with small red blisters. The difference between impetigo and chickenpox is that impetigo usually forms around the mouth and nose first, and the scabs the blisters leave behind have a distinct honey-like color to them.
- Scabies – Scabies can cause a rash with small blisters that appear visually similar to chickenpox. However, scabies rashes usually come with raised lines on the skin where the scabies mites burrow, and scabies doesn’t cause flu-like symptoms.
- Contact dermatitis – Sometimes, skin can react to direct contact with an allergen or irritant, such as poison ivy. The symptoms of a reaction depend on the cause but may include an itchy rash or blisters. However, these kinds of reactions are often limited to the area that came in contact with the allergen or irritant.
When to seek immediate treatment for chickenpox
In healthy children and people with existing chickenpox immunity, many cases of chickenpox resolve on their own. However, since it can be more serious in adolescents and adults, it’s still important to talk with a doctor if you or a child over 12 years old shows symptoms of chickenpox. It’s also important to talk with a doctor about possible chickenpox exposure if:
- Your child is less than 1 year old
- You or your child have a weakened immune system
- You’re pregnant
As for symptoms, you should talk with a doctor if you or your child experience:
- Severe itching
- Severe cough or abdominal pain
- Vomiting
- Difficulty breathing, walking or waking up
- Confusion
- A rash that lasts longer than two weeks
- Pronounced redness, warmth or sensitivity in rash-affected areas
- A rash that appears with bruising, bleeding or leaking pus (pus is thicker and less clear than blister fluid)
- A rash on an eyeball
How long chickenpox lasts
After exposure, chickenpox has an incubation period of around 10-21 days before symptoms appear. Chickenpox becomes contagious around 48 hours before symptoms appear and stays contagious for as long as unscabbed blisters are present.
Chickenpox blisters will appear continuously for a few days to a week, and it takes around a week for a new blister to scab over. Once all of the blisters have scabbed over, you’re no longer considered contagious.
How chickenpox is diagnosed
A doctor or clinician can usually tell if you have chickenpox based on the rash. However, it’s standard procedure to collect a blister or blood sample in order to confirm the diagnosis.
What are the treatment options for chickenpox?
Since most cases of chickenpox resolve on their own, treatment generally focuses on managing fever and itchiness. However, a doctor may prescribe antiviral medications for people at a higher risk of serious symptoms or complications from chickenpox. Antivirals are more effective the sooner they’re taken and should ideally be started within 24 hours of the chickenpox rash appearing.
Home remedies for chickenpox
There are several things you can do at home to relieve uncomfortable symptoms caused by chickenpox. Home treatments for managing itchiness and fever from chickenpox include:
- Cool baths with baking soda or oatmeal added to the water
- Calamine lotion or cool compresses
- Keeping fingernails trimmed to help prevent infection from scratching
- Oral antihistamines (talk to a doctor before giving antihistamines to your child)
- Ibuprofen or acetaminophen (do not give your child aspirin)
As with any infection that involves a rash, it’s important to change clothes and bedding daily, avoid sharing objects and to wash your hands thoroughly with soap and water before and after touching the rash.
Getting vaccinated is the most effective way to prevent chickenpox
If you’ve never had chickenpox, getting vaccinated is the best way to prevent it. Chickenpox vaccination prevents the vast majority of infections and significantly reduces your risk of having a serious case if you do catch it. According to the CDC, chickenpox cases have dropped by over 97% since the introduction of the vaccine.
If you think you might have chickenpox, talk with a doctor
Chickenpox may be far less common than it used to be, but it’s still important to take it seriously. If you suspect that you or your child have chickenpox, schedule an appointment with a primary care provider. They can make a diagnosis, provide treatment and give recommendations to relieve symptoms.
