Varicella (Chicken pox)

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It is a highly infectious disease caused by Varicella zoster virus (VZV)

Signs and symptoms

  • Red macular rash with a central vesicle (blister) on the trunk, face, oral mucosa and scalp
  • Pustules, crusting; intense pruritus
  • Fever, headache, loss of appetite

Complications

  • Bacterial infections of the skin and soft tissues in children
  • Pneumonia and encephalitis (especially in adults and immunocompromised patients)

Investigations

  • Diagnosis is clinical

Treatment objectives

  • Reduce morbidity
  • Relieve itching and treat secondary bacterial infection
  • Prevent complications

Non-pharmacological

  • Avoid scratching if possible
  • Cut long nails

Pharmacological treatment

Adult:

Apply calamine lotion 2−3 times daily to the skin

Paracetamol oral

500 mg−1g every 6-8hrs if necessary, in case of fever.

If lesions are infected give antibiotics

Adult:

Flucloxacillin oral

500 mg every 6 hours for 5−7 days

Child:

125 − 250 mg every 6 hours for 5−7 days.

Note: If the patient is allergic to penicillins, give erythromycin

In severe cases of itching give antihistamines

Promethazine oral

25 mg 1 to 3 times daily

Acyclovir oral

Adult:

200mg/kg (up to a maximum of 800mg) 4-5times daily for 5days

Child:  

2 years of age and older (40kg or less):20mg/kg, for 4times a day for 5days

 

Treat pain and fever

Paracetamol oral

3 months−1 year: 60−120 mg every 6-8 hrs if necessary

1−5 years: 120−250 mg every 6-8hrs if necessary

6−12 years: 250−500 mg every 6-8hrs if necessary

  • Apply calamine lotion 2−3 times daily to the skin
  • Give promethazine orally to relieve itching

 Promethazine oral

Child:

2−5 years: 5 mg twice daily

5−10 years: 10 mg twice daily

Give antibiotics only if lesions are infected.