I have received a quite a few questions concerning chicken pox. Below is a list of frequently asked questions (FAQs) concerning this topic.

What is chicken pox?

Chicken pox has a fancier medical name called varicella zoster. It is a virus which infects the body causing the typical illness. To understand why it is called "chicken pox" see "Why is it called Chicken Pox?".

How do you catch chicken pox?

Humans are the only animals that get chicken pox. Therefore, the only way to catch it is by being around a person who has it. The virus is spread through secretions and by tiny droplets, so sharing saliva (kissing, infant's toys, etc.), sneezing, and coughing are good ways to get the virus from one person to another.

What is the incubation period?

When we get infected with any cold virus, it takes a while for the virus to replicate enough to cause symptoms. This period of being infected before symptoms show up is called the incubation period. The incubation time for chicken pox prior to the onset of the cold symptoms can be up to 24 days.

What are the symptoms?

Most people know about the rash, but chicken pox starts out looking just like a common cold. Runny nose, sneezing, cough, and fever are typical first symptoms of chicken pox. Then about three to five days later the rash shows up. The rash itself looks like dots ranging from the size of an eraser head to about the size of a dime. Within each of these dots is a fluid filled vesicle which may pop over the course of the following days. The lesions may be painful, itch, or not be bothersome at all. They may be found anywhere on the skin, in the mouth and within the vaginal area and even unseen within the penis. Because of this, it may be painful to urinate.

How long does the rash last?

In general, the lesions stop popping up about two to three days after the first one appeared. It then takes about three days for the lesions to crust over.

How long is someone with chicken pox contagious?

The most contagious time occurs when the person is going through the cold-like symptoms which is usually two to five days before the rash shows up. Therefore, the time in which someone is most contagious occurs before the person even knows he has chicken pox! After the rash appears, the person is infectious for about 5 days or until all the lesions have begun crusting over. This does not mean the lesions need to have gone away or fallen off, just crusted over.

When can my child go back to school/daycare?

The official recommendation is six days after the rash begins. They may return even earlier if all the lesions have crusted over before this time. However, despite what experts say, daycare facilities and schools often have their own idiosyncratic rules that may require the child to stay out longer than this. If this is the case, sometimes it is helpful to have a pediatrician come and talk with the daycare facility or school about what is medically the optimal time to exclude these children.

How are the symptoms of chicken pox treated?

Unfortunately, there isn't much that can be done to completely eliminate the symptoms once a child is infected with chicken pox. Therefore, treatment is geared to trying to alleviate the pain, itch, and fever of chicken pox.

Fever:
Because of the association of Reye's Syndrome and aspirin use during chicken pox, acetaminophen (Tylenol, Tempra, etc.) should be the only medication used to treat fever during this illness. Be sure and use the cheapest brand of acetaminophen and give the proper dose for the age and weight of your child. A common cause of acetaminophen "not working" is the dose given is the same that was given to the child several months previously. If your child has grown a lot, the proper dose will have changed as well.

Itch:
There are a number of home remedies that may be tried. One of the more helpful things is to give the child oatmeal baths. The oatmeal can be quite a pain to clean from the tub, but may give your child significant relief. The oatmeal can be used directly off the grocery shelf or commercial brands may be purchased such as Aveeno. Remember, baths do not spread the infection to other parts of the skin. Wet compresses with cool wash cloths may help as well. Be sure to cut the child's fingernails to reduce the risk of the child damaging the skin significantly and leaving it open for infection. Calamine lotion is often used as well to ease the itch. Medications such as diphenhydramine (Benedryl) may also help with the itching although the side-effects of sleepiness or, more uncommonly, agitation may occur. However, this medication should not be given to children under two years of age before speaking with your physician. Other prescription medications such as hydroxyzine (Atarax) for itching can be prescribed by your doctor.

Pain:
Remember the pox lesions may occur in the mouth as well. While you want to encourage fluids in the child with chicken pox, be sure not give the child anything that is too salty or acidic such as orange juice if these lesions are present in the mouth.

Can't Acyclovir (Zovirax) make chicken pox go away faster?

An in-depth discussion may be found in "Would you prescribe Zovirax for chicken pox scars?" however, to summarize: Acyclovir is an anti-viral medication that has been proven to decrease the symptoms of chicken pox, decrease the number of lesions, and decrease the amount of time it takes for the lesions to crust over. However, this decrease is only one day of illness and is only effective if the medication is started within the first day of the rash. In addition, it is a rather expensive medication that must be taken four times per day, therefore, the current recommendation is to not use this medication unless the child is at particular risk of having severe chicken pox. These children would include those who:

1. Are over the age of 12
2. Have certain lung diseases
3. Who take aspirin on a daily basis for other medical conditions
4. Who take steroids either by mouth or inhaled steroids

Are there more serious complications associated with chicken pox?

Chicken pox is a relatively benign infection for most. However, more serious complications do uncommonly occur, and it is these more serious complications that constitute the biggest argument to give the chicken pox vaccine. Some of these complications include:

Skin:
The most common of these otherwise uncommon complications is infection of the skin due to bacteria invading the open sores of the chicken pox. Most of the time, these skin infections are easily treated with antibiotics by mouth. However, occasionally the infection spreads too fast or does not come under control with oral antibiotics. In these cases, antibiotics by vein are required.

Brain:
An inflammation or swelling of the brain causing confusion or incoordination may occur. This usually happens after the lesions begin to crust over. Because of this timing, it is felt that this complication called encephalitis is caused by the body's immune reaction rather than the infection itself. Almost always, the child gets better over time without any long lasting consequences. Incoordination or Acute Cerebellar Ataxia is the more common brain complication of chicken pox.

Lung:
The varicella virus may infect the lungs causing significant swelling within them called pneumonitis. This is most often a complication experienced by adults who get chicken pox, but it can rarely happen to children as well.

Life-threatening infection:
There is an association with the Group A Streptococcus bacteria (the same one that causes strep throat) and chicken pox. This bacteria may invade deeper tissues of the body causing life-threatening illness. A more personal perspective about this complication may be found in "Chicken Pox & Group A Strep".

Is chicken pox more dangerous for some children?

Children with immune problems can have significant problems if infected with chicken pox. These include those children infected with HIV, the virus that causes AIDS, those with cancer, those on steroids for other illnesses, and newborn babies.

Should my child with chicken pox avoid pregnant women?

Yes. If the pregnant woman has definitely had chicken pox in the past there should not a risk of exposing the fetus to the virus. However, to be on the safe side, children with chicken pox should avoid coming in contact with pregnant women.

What is the danger to the fetus if a pregnant woman gets chicken pox?

Essentially the risk is rather small depending upon how far along the pregnancy is. However, it is not insignificant. For a more in-depth discussion about this topic, I suggest reading my previous question "Chicken Pox and Pregnancy".

Can someone get chicken pox more than once?

Almost never. Except for children and adults who have immune system problems, getting chicken pox confers life-long immunity. Now, the minute I say never, someone will come up with a story about how he or one of his family got it twice. While this is a possibility, it is extremely rare. Most of the time, these stories turn out that the original chicken pox "infection" was a rash that was mistaken for chicken pox.

What can be done to prevent chicken pox?

The most effective way to prevent chicken pox in children is to get the vaccine. The American Academy of Pediatrics recommends that all children over 12 months of age receive this vaccine. The vaccine licensed in the U.S. has been used for a little over six years now and immunity has been holding relatively strong. About 95 percent of children remain immune after six years. However, because it is not 100 percent, these children will most likely require booster shots as an adult. This is where the controversy comes in. Adults typically do not followup with their booster shots, and chicken pox is more deadly in adults. Therefore, many are concerned about passing on the illness to adults who receive the chicken pox shot but become unknowingly susceptible to chicken pox due to waning immunity.

Should I give my child the chicken pox vaccine?

This is entirely up to you and your child's doctor. As I said, the American Academy of Pediatrics recommends vaccinating all children against this disease. There are a lot of pros and cons to this issue, so open discussion with you and your child's doctor is important.

How do I keep my child's pox lesions from scarring?

The most important thing is to try to control the itching as much as possible. Scarring primarily occurs due to damage to the skin from scratching or from infection of the lesions. Be sure to trim the nails of your child and follow the anti-itch regimens outlined above. If any of the lesions begin to get very red or develop pus in them, be sure to call your doctor as this may be the first sign of infection. And finally, once the pox lesions have healed, be sure to use lots of sunscreen. These spots will tend to lack pigment for quite a few months. During this time, sun damage could promote scarring of these dots.

What is Herpes Zoster and is it related to chicken pox?

Herpes zoster is a painful rash that is caused by the same virus as chicken pox. However, it usually occurs after the person has had chicken pox. The reason for this is that after we get chicken pox, the virus may not be entirely eliminated from the body. The virus may, instead, reside dormant in certain nerves of the body. Then for reasons not entirely understood, the virus becomes active again, but this time only causes problems in certain parts of the body rather than all over the body like in chicken pox. The symptoms of herpes zoster depend upon which area of the body is affected. It usually manifests itself as a painful rash occurring along the chest, abdomen, or back. However, it may occur anywhere on the body. The rash is red and has little fluid filled vesicles which eventually pop and crust over much like the vesicles in chicken pox do.

Is herpes zoster contagious?

Because the virus that causes herpes zoster is the chicken pox virus, persons with active herpes zoster are at risk for transmitting chicken pox. Like chicken pox, the person is considered infectious until the rash has crusted over. Persons who have not had chicken pox are at risk for getting it if they come in contact with the fluid oozed from the vesicles. Those with chicken pox transmit the virus most effectively by respiratory means (sneezing, runny nose, saliva, etc.) However, unlike chicken pox, those with herpes zoster do not transmit the virus by respiratory means. It is only transmitted by the fluid from the vesicles of the rash. Therefore, transmission of the virus may be substantially minimized by covering the rash well and being very careful to wash hands thoroughly.

I hope this helps.