Prather Pediatric and Allergy Center - Ask Doctor Brent

Printer Friendly Version

Title: Chicken Pox, New Concerns and Future Treatments

Category: Child Care


Chicken pox has been around almost as long as recorded history. It is, in most cases, a self limited disease, which is mild in childhood but occasionally severe in older children and adults. In today's world, with many surviving small prematures, many surviving cancer patients and increasing numbers of immuno-suppressed patients, chicken pox is a big concern. For these high risk patients, new life saving treatments are available. They include a vaccine called VZIG which stands for varicella-zoster immunoglobulin and anti-viral medicines, primarily acyclovir. With the use of this vaccine and this anti-viral medication, these high risk patients can be saved from life threatening disease and complications should they encounter chicken pox.

A typical course of chicken pox includes a two week incubation period. This means, from the time you are exposed to the virus, you will grow the virus in your body until you first begin to show symptoms. The initial symptoms will be fever, fatigue and a drop in appetite. Then papules, or pimple like lesions, will begin to pop up over the trunk and scalp. These will change into vesicles which look more like pustular sores. A few days later these will scab over and will begin to dry up. The entire course of itchy sores lasts anywhere from about three to seven or eight days. The sores then dry up and the patient becomes non-contagious. Children can return to school and adults can return to work. Most people have seen chicken pox and can easily recognize it as it is erupting.

What should we do in treating a routine case of chicken pox? The first thing is to control the itching. This is best done by frequent soaks in a cool bath with baking soda and oat- meal. The oatmeal can be garden variety or bleached Aveno oatmeal bought at the drug store. This has a drying, soothing effect on the skin and it significantly decreases itching. Next, you can take anti-itching medications such as Benadryl, Atarax, Hismanal or any other antihistamine. Finally, some people like to use creams such as calamine or Caladryl. Personally I find that the itching is better controlled if you don't rub creams on the sores because as they dry they tend to itch a little more. The second step is to prevent the sores from getting infected. This is best done by having a nice soapy bath a least once a day with a good soap such as Ivory, Dial or Dove, or a antibacterial soap such as Betadine, Phisohex or Hibiclens. Should any of the sores become infected, it is important to see your doctor because Bactroban ointment can be applied to the sores reversing the infection or an antibiotic taken by mouth can also dry up the sores rapidly. If the infected sores are not treated, infection may spread and cause permanent scars on the skin. A couple of important no-no's in treating chicken pox include:

1. Never rub cortisone cream on sores.

2. Never take aspirin when you have chicken pox. Aspirin taken along with chicken pox is linked with Reye's Syndrome which is a potentially deadly disease in children. Be cautious not only with aspirin but also aspirin containing products such as Alka Seltzer, Pepto Bismol and dozens of over-the-counter products which contain salicylates.

For the majority of healthy children and adults, chicken pox will be a week of discomfort but something they will get over without too much difficulty. For high risk patients, however, it can be a true life-threatening event. These high risk patients include anyone with congenital immune deficiencies, AIDS, malignancies, organ transplants, anyone on immuno suppressant therapy, anyone with sever malnutrition, severe burns or marked prematurity such as less than 28 weeks of gestation or less than 1000 g. weight. Finally, a patient who gets chicken pox in the fifth to tenth day of life is a potentially high risk patient and your doctor needs to be consulted right away. For all of these high risk patients, your doctor will probably recommend taking VZIG as rapidly as possible to prevent catching the disease or at least to minimize the severity of the disease should it be caught. This ideally should be given within the first few hours but always within the first 96 hours of exposure to be effective.

Should the chicken pox occur anyway, treatment with antiviral medicines including Acyclovir and other potential medicines can be lifesaving.

When will we immunize everyone against chicken pox and stop this nuisance disease which causes weeks of lost school and work? Probably within the next few years, a well tested vaccine will be available and will be recommended to be given to the general population along with the many other childhood vaccines. One of the concerns at present is that patients getting the vaccine may develop shingles. Studies show that the percentage of developing shingles is lower than the percentage that would develop shingles from the natural disease anyway. Another concern is that the vaccine will cause a chicken pox- like disease. This has not been a problem with the vaccine so far. The final concern is that the vaccine may have potentially dangerous side affects. This also has not occurred in large studies so far. Most likely the vaccine will be approved for the general population soon. It is now being used in high risk patients such as leukemia patients. It may be given along with the measles, mumps and rubella immunization at 15 months of age.