Pediatric Chickenpox

Varicella (chickenpox), is caused by the varicella-zoster virus. The disease is generally regarded as a mild, self-limiting viral illness with occasional complications.

Varicella is common and highly contagious and affects nearly all susceptible children before adolescence. A significant number of varicella cases are associated with complications, among the most serious of which are varicella pneumonia and encephalitis.

The following are the most common presenting symptoms of varicella:

• Low-grade fever preceding skin manifestations by 1-2 days
• Complaints of abdominal pain by some children
• Pleomorphic rash, usually starting on the head and trunk and spreading to the rest of the body
• Typically, complaints of intense pruritus
• Headache
• Malaise
• Anorexia
• Cough and coryza
• Sore throat Children with eczema or dermatitis may have severe skin manifestations during varicella.

Immunocompromised children often have severe and complicated varicella, and their mortality rate is higher than that in immunocompetent children. Such children are at high risk for developing progressive varicella with multiple organ involvement. These children may have prolonged high fever, prolonged extensive rashes, and hepatitis.

Examination of rash the diagnosis of varicella is made upon observation of the characteristic chickenpox rash. This rash appears in crops. Skin lesions initially appear on the face and trunk, beginning as red macules and progressing over 12-14 days to become papular, vesicular, pustular, and finally crusted. New lesions continue to erupt for 3-5 days.

Lesions usually crust by 6 days (range 2-12 d), and completely heal by 16 days (range 7-34 d).

Prolonged eruption of new lesions or delayed crusting and healing can occur with impaired cellular immunity

Fever is usually low grade (37,7o C) but may be as high as 41o C. In otherwise healthy children, fever typically subsides within 4 days. Prolonged fever should prompt suspicion of complication or immunodeficiency. Although tachypnea may be seen with fever alone, respiratory distress might represent pneumoni

Treatment & Management

Treatment approaches include supportive measures, antiviral therapy, and management of secondary bacterial infection.

Supportive Therapy Manage pruritus in patients with varicella with cool compresses and regular bathing. Discourage scratching to avoid scarring.

Trimming the child’s fingernails and having the child wear mittens while sleeping may reduce scratching. Oral antihistamines, such as diphenhydramine and hydroxyzine, are used for severe pruritus. The routine use of acyclovir in healthy children is recommended by the AAP if it can be given within 24 hours after the rash first appears in children older than 12 years, those with chronic cutaneous or pulmonary disorders, those on long-tern salicylate therapy, and children receiving corticosteroids