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Therapeutics in Dermatology
A reference textbook in dermatology

Chickenpox and Herpes zoster

2 August 2019, by QUEIRO C.

1 - ACKNOWLEDGEMENTS

Chapter written with the help of the EADV, the Fondation René Touraine and the Therapeutics in Dermatology

2 - CHICKENPOX

2.1 - OVERVIEW

Chickenpox is a common infection that affects mostly children, although people can get it at any age.

2.2 - SYMPTOMS AND CLINICAL MANIFESTATIONS

Chickenpox is usually diagnosed clinically. The disease usually starts with red spots that can appear anywhere on the body. These spots fill with fluid and may burst. The process usually starts on the scalp, then affecting the trunk, and finally the arms and legs. The lesions may be found in various developmental and healing stages and are usually very itchy. Fever and loss of appetite can be present, as well as respiratory symptoms. The disease is usually much worse in adults.

2.3 - CAUSES

Chickenpox is caused by a virus called Varicella Zoster. The disease is usually acquired by breathing in viral particles that come from an infected person, but transmission through direct contact with clothes or bedding that have fluid from the blisters on it is also possible. It takes 1 to 3 weeks from the time you are exposed to chickenpox for the spots to start appearing.

Chickenpox is contagious from 2 days before the spots appear to until they have crusted over (in average 5 days after the appearance of the first spots). It is possible to get chickenpox more than once, although it is unusual.

2.4 - TREATMENT

Chickenpox usually gets better by itself within a week. It is important to stay away from school or work until all the spots have crusted over. Oral antiviral agents may be considered for specific cases. There is a vaccine for prophylactic use in healthy children and adults. If you develop chickenpox during pregnancy, you are at risk of complications; for your baby, the risks depend on the timing of transmission. You should always talk to your doctor in this circumstance.

2.5 - TIPS FOR MANAGING

Things you should do:

  • drink plenty of fluid
  • take paracetamol in case of pain or discomfort
  • take an antihistamine medicine to reduce itching
  • bathe in cold water and pat the skin dry (without rubbing)
  • use cooling creams or gels from your pharmacy
  • dress in loose clothes
  • keep the lesions clean, cut your child’s nails and avoid scratching in order to prevent bacterial infection

Things you should not do:

  • do not use ibuprofen unless advised by your doctor
  • do not give aspirin to children under 16
  • do not be around pregnant women, newborns or people with a weakened immune system (such as those with cancer), as chickenpox can be particularly dangerous for them

Ask for an urgent appointment if:

  • you’re an adult and have chickenpox
  • you’re pregnant and haven’t had chickenpox before and have been near someone with it
  • you have a weakened immune system and have been near someone with chickenpox you think your newborn baby has chickenpox

3 - SHINGLES

3.1 - OVERVIEW

Shingles and chickenpox are caused by the same virus. When it gets into your body, the first disease it causes is chickenpox. After chickenpox runs its course, the virus remains hidden in your nervous tissue near the spinal cord and brain. Sometimes it “wakes up” and travels along nerve fibers to the skin, causing shingles, also called herpes zoster.

3.2 - SYMPTOMS AND CLINICAL MANIFESTATIONS

The first sign is usually a tingling or painful feeling in an area of skin, which may be accompanied by fever and general weakness. The disease then presents with a row of raised dots on one side of the trunk, limbs or face. The skin often looks red in that area, and the rash eventually turns into painful, red, fluid-filled small blisters. These should begin to dry out and crust over within 7 to 10 days, and most people can expect the rash to heal within 2 to 4 weeks. When it occurs in the face, shingles may affect the eye, in which case you should also be evaluated as quick as possible by an ophthalmologist. In some cases, pain along the site of the rash can continue for several months or longer, which is known as post herpetic neuralgia.

3.3 - CAUSES

Shingles usually occurs decades after the patient’s first exposure to Varicella Zoster virus. A weakened immune system is often present, so you are more likely to get shingles if you have underlying diseases such as cancer or HIV, if you are 50 or older, if you suffer from hematological conditions, if you are under a lot of stress or if you are taking long-term medicines that depress your immune system.

Shingles cannot be passed from one person to another. However, if you’ve never had chickenpox or the chickenpox vaccine, it is possible to get chickenpox from someone with shingles through direct contact with active blisters. Once the rash has developed crusts, the person is no longer infectious. Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered. It is important to avoid pregnant women who did not have chickenpox before, people with a weakened immune system and babies less than 1 month old. It’s possible to get shingles more than once, although it’s unusual. Droplet or airborne spread is less common than transmission through direct contact with the lesions, but it can occur in cases of disseminated shingles or in patients with a depressed immune system.

3.4 - TREATMENT

Episodes of shingles generally resolve without intervention in up to 4 weeks. Antiviral therapy may accelerate recovery and decrease complications such as postherpetic neuralgia. Ideally, therapy should be initiated within 72 hours of symptom onset. Oral antiviral agents include acyclovir, famciclovir and valacyclovir. It is important to stay off work or school until the rash has dried out. Two vaccines are approved for adults in order to help reducing the risk of getting shingles. If one gets shingles after being vaccinated, the symptoms can be much milder.

3.5 - TIPS FOR MANAGING

Things you should do:

  • take paracetamol to ease pain
  • keep the rash clean and dry to reduce the risk of infection by using a disinfectant
  • wear loose-fitting clothing and use a cool compress a few times a day
  • keep your fingernails trimmed short in order to prevent scratching and bacterial infection

Things you should not do:

  • do not let dressings or plasters stick to the rash

Ask for an urgent appointment as soon as possible if you think you have shingles.

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