Treating Chickenpox

by Food and Drug Administration (FDA)

Public health officials don't know yet how many children will be vaccinated since the chickenpox vaccine isn't required for school admission at this time.

In otherwise healthy children and adults, the disease should be allowed to run its course. But that doesn't mean the symptoms should be ignored. Calamine lotion applied to the lesions may offer some relief from the infamous itch of the chickenpox rash. Soaking in a cornstarch, baking soda, or oatmeal bath may also do the trick. However, because any relief is at best temporary, doctors advise parents to cut children's nails very short, since scratching can lead to secondary skin infection by bacteria on the skin, such as staphylococcus ("staph") and permanent scarring. A daily bath with soap is also recommended to clean as much bacteria off the skin as possible.

A non-aspirin pain reliever and fever reducer such as acetaminophen (Datril, Tempra, Tylenol, and others) can ease headaches, fever, or general malaise. Aspirin or any medication that contains aspirin or salicylates should never be used because of the risk of Reye syndrome, a rare but serious illness that typically strikes children and teenagers just as they appear to be recovering from the flu or chickenpox.

If a doctor visit is necessary, pediatricians usually make special arrangements to see children who might have chickenpox to avoid exposing others.

"They might see [those children] after hours or when the office isn't busy," says Mary L. Kumar, M.D., a pediatrician in Cleveland. Although diagnosis may be possible over the phone, "I like to take a look myself," she says. "Over the phone can be pretty accurate if other children in the family just had chickenpox. But there are many other rashes that can look somewhat like the varicella [chickenpox] rash, so I don't think it's easy over the phone to be certain."

During the course of the infection, the doctor should be called if the patient's temperature goes above 102 degrees Fahrenheit (39 degrees Celsius) or any fever lasts longer than four days, or if areas of the rash become very red, warm, or tender, which may signal a bacterial infection requiring antibiotics.

In February 1992, FDA approved the use of oral Zovirax (acyclovir) to treat chickenpox in otherwise healthy children. (FDA had already approved the drug to treat genital herpes and shingles.) When a patient receives oral Zovirax within 24 hours after the rash appears, the number of lesions are reduced, and average recovery time is shortened approximately one day.

However, the American Academy of Pediatrics does not recommend the use of oral Zovirax in otherwise healthy children. The academy says the medication's relief of chickenpox symptoms is minimal, it's extremely difficult to start it during the first 24 hours, and there is a potential for unforeseen dangers when treating large numbers of children who are at low risk of developing complications. The academy recommends use of oral Zovirax only in people at high risk for severe chickenpox or complications, including:

• healthy nonpregnant teenagers and adults
• children over 1 year who have chronic skin or lung disorders, or who must take aspirin daily for conditions such as arthritis
• children taking corticosteroids for conditions such as asthma.

A biological product that actually prevents infection is available for people at high risk. But the product, varicella-zoster immune globulin, or VZIG (doctors pronounce it "vee-zig"), must be administered within 96 hours of exposure, long before symptoms appear. And it serves little purpose to the otherwise healthy population because VZIG gives only temporary protection.

VZIG is prepared from the plasma of normal blood donors who have high levels of antibodies to the varicella virus, which causes chickenpox. It confers a "passive" immunization that lasts only about three months.

The Centers for Disease Control and Prevention recommend VZIG for the following

• high-risk individuals who have no immunity to chickenpox:
• immunocompromised children and adults
• newborns whose mothers came down with chickenpox five days before to two days after delivery
• premature infants exposed after birth.

VZIG may be recommended for mothers who are exposed during the first trimester. However, taking VZIG at this time only benefits the mother's health. There is no indication that VZIG can prevent the birth defects associated with the chickenpox virus.

Those at highest risk for complications are not candidates for the chickenpox vaccine. (Healthy teenagers and adults, who are considered at high risk for chickenpox complications simply because of their age, can get the vaccine.)

"People who have compromised immune systems are more likely to get worse reactions to the vaccine because it is a live virus," says FDA's Philip R. Krause, M.D. "The hope is that if enough healthy children get the vaccine there will be less natural chickenpox floating around and [high-risk] people will not be exposed."

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.