Dealing with Chickenpox

Infectious diseases are commong during this hot season..Chicken pox is one of them..It is a common viral infection prevalent all over the world and is seen throughout the year..The incidence is a little higher in summer..Although chicken pox is a self limiting condition,it can be sever at times..It can be life threatening as well..Antiviral drugs are available now and so are chicken pox vaccines..It is also called Varicella..It is a highly contagious viral disease caused by Varicella-Zoster virus characterised by high fever and diffused skin rash..It usually affects children below the age of 10 years..The condition is rather mild in them with mild fever and moderate rash..In adults Varicella is quite severe with high fever and extensive skin rash...Scarring is also severe..
Clinical features:

The incubation period of chicken pox is about 14 days..Affected persons are infective during the later stages of the incubation period(about 5 days prior to the apperance of fever and rash) and they remain infectiuos till the lesions dry up(up to about 7 days after the appearnce of skin rash)Varicella is characterised by modertae to high fever,skin rash and ulcers in the mouth and throat..It not only involves the skin but also the gastro-itestinal tract and also internal organs..

The skin rash starts as reddish spots which soon become blisters..Successive crops of blisters appear over the next few days mainly on the trunk and face with scattered lesions over extremities..Over the next few days the blisters turn in to pustules with central depression and subsequently dry up forming crusts..Itching can be present from the beginning but is more common when the lesions are dry..The crusts eventually fall off leaving superficial depressed spots and these spots take a couple of months to clear..Scarring is unusual in chicken pox..Larger lesions and lesions which get secondarily infected due to scratching leave characteristic rounded and depressed scars..The entire episode from the strating of fever and skin rash till the crusts fall off lasts for about 15 to 20 days..

Pregnancy and chickenpox:

When chicken pox appears during the first 20 weeks of pregnancy,congenital malformations of fetuses appear..Fetal anomalies include stunted limbs,large skin ulcers and scars..The condition can be sever with extensive rash and a few can develop pneumonitis..The risk for spontateous abortion is 3%..If the mother develops chicken pox between 5 days before the delivery,the new born can also develop chickenpox and it is usually very severe..

Treatment:

Mild to moderate attacks are managed at home and if the condition is severe it is necessary to admit the patient in the hospital ..Antiviral therapy should be started..Acyclovir,Famcyclovir or Valcyclovir are the common antiviral drugs used for the treatment..

In children as the condition rather mild ,anitviral therapy is not recommended ..It is given only when the condition appears progressing towards the severe spectrum and in children suffering from atopic dermatitis where the condition can be very severe and can lead to serious complications..

But in adults,the condition is usually severe and so antiviral therapy must be started as soon as diagnosis is made..Severe chicken pox in pregnant mothers and newborn children should be treated with antiviral medications..Antiviral therapy helps to bring down elevated body temperature,prevents the appearance of new lesions withina couple of days,the existing lesions heal faster wihout much scarring and complications like pneumonitis and encephalitis are extremely rare..

Antiviral therapoy doesnot alter the development of adequate immunity to reinfection.For fever and itching,symptomatic treatment with Paracetamol and antihistamines are given respectively..

Topically,cleansing the lesions with dilute potassium permanganate solution and application of dilute calamine lotion gives a soothing effect..

In india neem baths are given...The water is soaked with neema leaves with a dash of turmeric powder for faster healing of lesions..

If there is secondary infection,topical and systemic antibiotics are needed..Chickenpox scars are usually superficial and heal after a few weeks..In case od deeper scars microdermabrasion or chemical peeling may be needed..Light food must be taken during the course of this disease..

Prevention:

Chickenpox vaccine is indicated for active immunization against chickenpox from the age of one year..It is also advised for highly susceptible healthy contacts if they had not suffered from chickenpox earlier..A single dose is given for children between ages 1 to 12 years..For persons above 13 years of age,two doses are given at an interval of 6 to 10 weeks..After vaccination,prevention of severe varicella is virtually 100%..It is contraindicated in pregnancy..Pregnancy should be avoided for three months after vaccination..About 3 to 4 % of vaccinated individuals can develop mild form of chicken pox with a few scattered lesions with mild or no fever and the condition clears within a week..

A person who has had chickenpox develops immunity and the condition does not recur..The varicella zoster virus can remain dormant in the body after initial infection and sometimes get reactivated to cause the painful Herpes Zoster..