Chickenpox  is caused by a virus called varicella that usually starts with a fever.  The rash develops a day or two after the start of the fever.   The rash looks like a small, red bump that has a thin water blister surrounded by a small area of redness on the skin around the blister (the appearance has been described as a "dewdrop on a rose petal"). These blisters then become open sores that finally dry and crust. There are repeated crops of sores for 4 to 7 days. The first usually appear on the head and neck area. The arms and legs and then palms and soles appear with lesions near the end of the course of the disease.

• The incubation (time from exposure to time of the child having the disease) is anywhere from 10 to 21 days.
• Usually fever starts before the appearance of the bumps by 1 to 2 days.
• The contagious period starts 1 to 2 days before the appearance of the rash and ends when all the bumps are crusted, typically around 5 to 7 days.
• The most common season is late winter and early spring.
• A person is not contagious if they have been around someone with chickenpox, but have already had the disease or are not in the contagious period described above.
• Sores may also occur in the mouth, around or in the eyes and in the rectal and genital area.
• If you suspect your child has chickenpox and are making an appointment to be seen in the office, please alert the staff on the phone so they may make arrangements for your child to be seen without exposing other children in the office. Most uncomplicated cases of chickenpox do not need to be seen by a physician.

• The child is confused and delirious, difficult to arouse (try acetaminophen  or ibuprofen if febrile) or acting sick
• Stiff neck or severe headache
• Difficulty breathing
• Vomiting with signs of dehydration
• Purplish spots on the skin
• Child develops trouble walking, losing balance
• You suspect your newborn under 2 months old has chickenpox
• There is evidence of a rapidly spreading skin infection - large, red area of skin with red streaks radiating from the red areas

• Yellow discharge/pus draining from lesions or a large area of redness around a lesion
• Fever more than three days
• Intense sore throat
• Adults are exposed who have never had documented chickenpox
• You suspect a newborn (under 2 months old) in the household may have been exposed to chickenpox
• Your child is on a course of steroids for an underlying disease like asthma, arthritis and has been exposed to chickenpox
• Chickenpox near or in the eye

Relief of itching. Oatmeal baths (preparations such as Aveeno are available over-the-counter) are helpful. Calamine lotion may be placed on the itchy lesions. Over-the-counter antihistamines, such as Benadryl may be used. Lesions may occur in the mouth, and the key is to make sure fluids are encouraged to avoid dehydration. A bland diet (avoid salty foods and citrus) and cold liquids or popsicles are best tolerated.

Fever control. Never use aspirin with a child with chickenpox, because of the association with Reye's syndrome. Reye's syndrome is characterized by a child who is delirious and confused (out of proportion to the fever and despite fever control) and   vomiting. See fever for guidelines on fever control.

Infected chickenpox (impetigo). To prevent infection, keep the child's fingernails cut short and wash hands with an antibacterial soap frequently. If you suspect a minor skin infection starting, you may use an over-the-counter antibacterial ointment until you can call during office hours. If you see a rapidly spreading skin infection over a few hours, call the office immediately. Purplish spots on the skin may indicate a hemorrhagic or bleeding form of chickenpox and the doctor should be contacted immediately or taken to the emergency room.

Chickenpox vaccine (varivax). There is new vaccine to prevent against chickenpox. Please discuss the details individually with your physician. Children may receive it after a year of age.

Acyclovir (Zovirax). Oral medication with acyclovir, may shorten the course of chickenpox once the infection develops. It is not a cure for the disease. Please discuss this medication with your physician.

Shingles. Shingles is a localized case of chickenpox in a small area of the body. The outbreak of pox lesions follows a nerve root and occurs months or years after a primary infection with chickenpox. It occurs more frequently in adulthood. Some people develop this complication and some people do not. Discuss possible treatment with acyclovir with your physician.

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