Chickenpox mostly resolves on its own. But the two things families commonly get wrong both come at a cost: putting all sorts of things on the spots, and sending a child back to school too early. This article covers how to recognise the spots, how to ease the itching without causing infection, how long it stays contagious, and when you need to be seen.
Recognising chickenpox spots
Fever, tiredness, loss of appetite and headache usually come a day or two before the rash. Then the rash appears: starting on the face, chest and back before spreading over the body, and it can include inside the mouth and the scalp. It itches a great deal.
Each spot goes through three stages you can see with your own eyes: a raised pink-red bump, then a fluid-filled blister, then it breaks and crusts over dry. Most importantly: the rash comes out in successive waves, with new spots still appearing over several days. So at any one time the body carries new spots, fluid-filled blisters and dry crusted spots all together — the distinguishing mark of chickenpox.
On the first day the rash is still sparse, which makes it very easy to mistake. The table below gives differences you can see with the naked eye; it does not replace a diagnosis:
| Easily mistaken for | What is visibly different |
|---|---|
| Hand, foot and mouth disease | Spots concentrated on the palms, soles and inside the mouth; little spread over the rest of the body |
| Shingles | Spots form a band on one side of the body, burning rather than itching |
| Roseola, rubella | A flat rash, no fluid-filled blisters, no crusting in successive waves |
| Scabies, dermatitis, mosquito bites | Persistent itching, no accompanying fever, not appearing in waves all over the body |
How long it stays contagious, and when a child can go back to school
According to CDC, a person is contagious from one or two days before the rash appears until every spot has crusted over dry. Chickenpox spreads very easily through the air and through the fluid in the spots.
- Stay off school or work until every spot has dried and crusted. The basis is the state of the spots, not the number of days taken off.
- Keep the patient in a separate room with their own towel; avoid contact with pregnant women, newborns and anyone whose immune system is suppressed.
- Anyone in the household who has never had chickenpox and has not been vaccinated should ask a doctor straight away: vaccination soon after exposure can still mean a milder illness or no illness at all.
- In someone who has been vaccinated and still catches it, the spots may not crust over; in that case the marker for ending isolation is no new spots for 24 hours, to be confirmed by a doctor.
What to do at home straight away
Everything below needs no prescription, and it all serves one aim: easing the itch so the patient does not scratch. Scratching is how infection gets in, and it is the reason scars are left behind.
- Cut nails short and file them smooth; young children and babies should wear mittens for sleep.
- Keep washing normally with cool or mildly warm water, without scrubbing, and pat dry with a clean separate towel; wear loose, soft clothing and keep the room cool. Clean spots and cool skin itch less and get infected less.
- Give fluids regularly, in small sips. If there are spots in the mouth, choose cool, soft, bland food; avoid salty, sour, spicy and hard food.
- Write down the day the first spot appeared and the temperature readings you take — these are exactly the things a doctor will ask about.
- If a fever needs bringing down, ask a doctor or pharmacist. Paracetamol (acetaminophen) is the usual choice, but how it is used is decided by a doctor or pharmacist.
What you must NOT do
- Do not put folk remedies on the spots: poultices of leaves, toothpaste, turmeric, oils, ink, limewater, or ointments of unknown composition. They do not heal the spots faster, but they do make the spots hard to monitor and easy to infect.
- Do not give aspirin to a child with chickenpox: according to CDC, aspirin in children with chickenpox is linked to Reye's syndrome, a serious complication affecting the liver and brain. Read the ingredients of fever medicines carefully, because aspirin is in some combination cold remedies. Also avoid ibuprofen unless a doctor prescribes it.
- Do not pierce, squeeze or break the fluid-filled blisters; do not peel crusts before they come away on their own.
- Do not wrap the patient up, do not overheat them, and do not avoid washing — heat and sweat make the itching worse.
- Do not buy antibiotics or antivirals yourself. Chickenpox is viral; an antibiotic is only for when a doctor has established that there is also a bacterial infection, and an antiviral has to be prescribed by a doctor and only works when started early.
Who needs a doctor's assessment rather than home care
Chickenpox in a healthy child is usually mild. But the groups below are more likely to become seriously ill, and for them seeing a doctor early matters more than any amount of home care:
- Adults and teenagers, because it is usually more severe than in young children; newborns and babies under one year.
- Pregnant women, or anyone breastfeeding who has never had chickenpox: contact a doctor the same day.
- People with weakened immune systems: cancer treatment, immunosuppressant medicines or long-term corticosteroids, after an organ transplant, HIV infection. People with an underlying skin condition such as eczema.
- Anyone unvaccinated who has just had close contact with a case of chickenpox.
When you need to go in
Go to emergency care or call 115 (the emergency number in Vietnam) NOW if there is: difficulty breathing, fast breathing, chest pain; severe headache, a stiff neck, confusion, drowsiness and hard to rouse, seizure; unsteady walking or tremor; a lot of vomiting, unable to drink water, passing very little urine; spots close to or in the eye; skin around a spot swelling and reddening rapidly, hot, severely painful. — You need to be seen within 24–72 hours if: a high fever persists, or it came down and then returned; spots are oozing pus, smell, or have thick yellow crusts; there are so many spots inside the mouth that eating and drinking are impossible; the patient belongs to one of the higher-risk groups above. — If you are not sure, call and ask before deciding yourself.
Our part in this: a doctor visiting in person, and remote advice by video. If any of the signs in the box above are present, go to hospital first and call afterwards.
The information above is based on publicly available US CDC material on chickenpox and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
Sources
- CDC — About Chickenpox
