Symptoms of chickenpox

Written by Yuan Lin Yan
Infectious Disease
Updated on September 20, 2024
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Chickenpox symptoms are divided into two phases, namely the prodromal phase and the rash phase:

1. Prodromal phase. Infants and young children often have no symptoms or only mild symptoms, which may include mild fever, irritability, refusal to breastfeed, and the simultaneous appearance of rashes. Older children and adults may experience chills, mild fever, headache, fatigue, sore throat, cough, nausea, and loss of appetite. These symptoms last for one to two days before the rash appears.

2. Rash phase. The rash first appears on the trunk, then spreads to the face and limbs. It starts as red maculopapular rash, turns into papules within a few hours, and develops into vesicles. The vesicle fluid is initially clear but soon becomes cloudy, and itching often accompanies the vesicles. About a week later, the scabs fall off and heal, generally leaving no scars. However, if there is a secondary infection, pus-filled lesions may form, and scabbing and healing may take longer.

Chickenpox rashes are distributed centripetally, mainly located on the trunk and then the head and face, with fewer on the limbs. Some patients may also develop vesicles on mucous membranes such as in the mouth, throat, conjunctiva, and external genitalia, which break open to form ulcers. The chickenpox rash often appears in successive crops, so at the same site, maculopapular rash, vesicles, and scabs can be seen concurrently. Chickenpox is generally a self-limiting disease and tends to heal naturally within about ten days.

Children usually experience milder symptoms and rashes, while adults have more severe symptoms and are more prone to complications like chickenpox pneumonia. Individuals with lowered immune function are susceptible to disseminated chickenpox, where the rash may merge into larger vesicles. Infections during pregnancy can cause fetal malformations, premature birth, or stillbirth. If chickenpox occurs a few days before delivery, the newborn may contract neonatal chickenpox, which can be quite severe.

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When to get the chickenpox vaccine?

Chickenpox primarily affects infants and children, and the target group for chickenpox vaccination is mainly 1-12 years old. During this age period, most children enter preschool or elementary school institutions, and the chickenpox virus is highly contagious, transmittable through droplets and contact. Once one child contracts chickenpox, the surrounding children are almost certain to be infected too. Additionally, since there are currently no effective medications to cure chickenpox, it is best to vaccinate within this age range, namely 1-12 years old. Adults can receive the chickenpox vaccine without age restrictions. The timing can be decided based on individual circumstances, but it is generally recommended to get vaccinated before the onset of the peak season for chickenpox, which is best before the spring and winter seasons.

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What is chickenpox?

Chickenpox is a contagious disease caused by the varicella-zoster virus, commonly seen in children and prevalent in the spring season. The only source of infection is individuals with chickenpox. It spreads through respiratory droplets and direct contact. The disease is highly contagious and the general population is susceptible, but once recovered, long-lasting immunity is acquired. Clinically, symptoms may include mild fever, headache, fatigue, sore throat, cough, and loss of appetite, lasting for one to two days before the appearance of a rash. The rash first appears on the trunk and then spreads to the face and limbs. Chickenpox rash usually appears in batches, so at the same site, maculopapular rash, vesicles, and crusts can be seen. The crusts typically fall off about a week later, generally leaving no scars. Chickenpox is a self-limiting disease and typically resolves on its own in about ten days.

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How to treat chickenpox in children?

Chickenpox is a common contagious disease during children's growth. The chickenpox virus usually accompanies a rash and is also associated with high fever that persists and recurs. In such cases, parents should treat mild symptoms at home with symptomatic treatment, including oral antiviral drugs and fever-reducing medication. During the chickenpox, it is important to avoid certain foods that may exacerbate the condition, such as fish, shrimp, eggs, beef, lamb, and specific fruits like mangoes and durian, which are considered to be "heaty." A light diet and plenty of water are recommended. If the chickenpox is severe with extensive vesicles and persistent high fever, hospital visitation is necessary, where IV fluid treatment may be administered if needed. (The use of medication should be under the guidance of a doctor.)

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What are the symptoms and treatments for chickenpox in children?

Symptoms of chickenpox in children vary with age. Infants often show no symptoms or only mild symptoms, which can include mild fever, irritability, and refusal of breast milk, accompanied by a rash. Older children may experience mild fever, headache, fatigue, sore throat, coughing, and decreased appetite. These symptoms persist for one to two days before a rash appears. The rash initially appears on the trunk and then spreads to the face and limbs. Chickenpox rashes often emerge in batches, so the same area may show maculopapular lesions, vesicles, and crusts at the same time. The crusts typically fall off about a week later, usually leaving no scars. Secondary bacterial skin infection, pneumonia, encephalitis, and hepatitis are possible complications. In terms of treatment, infected children should be isolated until all the vesicles have crusted over. During the fever, they should rest in bed, consume an easily digestible diet, stay hydrated, and practice enhanced skincare to prevent infection of the vesicles. Antiviral treatment within 24 hours of rash onset can control the progression of the rash and speed up recovery. If a secondary bacterial infection develops, antibiotics should be used. In cases where encephalitis causes cerebral edema, dehydration treatments should be administered. The use of corticosteroids is not advisable for treating chickenpox.

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What should I do if my child has chickenpox?

Chickenpox is caused by the varicella-zoster virus infection and is highly contagious, primarily spreading through the air or droplets. Once infected, it quickly spreads to children or older adults who are in contact with each other. It is best for a child with chickenpox to go to a dermatology department at a formal hospital for antiviral medication treatment. Some children may develop a high fever and can take some fever-reducing medicine appropriately; if there is an inflammatory infection, some anti-inflammatory drugs can be taken as needed. During treatment, it is important to isolate, drink plenty of water, and eat a light diet. Try to avoid going outside in the wind or to crowded places to prevent cross-infection. (Doctor's answer is for reference only; medication should be taken under the guidance of a professional physician, do not take medicine blindly.)