Chickenpox

Chickenpox (varicella) and shingles (herpes zoster) are caused by the same virus (varicella-zoster virus) which spreads by droplets from the nose and mouth and from contact with chickenpox sores.

Chickenpox is highly infectious and mainly affects children under the age of 10 years. It can occur in adults but is unusual. Second attacks are very rare. In patients with immune deficiency whose resistance to infection is impaired by drug treatment or disease, chickenpox can be very serious and will require to be treated by their doctor.

The incubation time for chickenpox (i.e. time between contact and development of the rash) is usually about 2 weeks, but can vary between 11 and 21 days. Sometimes the rash is preceded by a day or so of feeling unwell with a temperature. The rash is very characteristic and only difficult to diagnose when very few spots are present, most parents can tell fully developed chickenpox very easily. Typically it starts with small red lumps which rapidly develop into small blisters called vesicles. The vesicles then burst, forming crusted spots over the next few days. The spots mainly occur on the trunk, face and hairline but may involve mucous membranes of the mouth. They tend to come out in crops for up to 5 days. The rash is often itchy. Once the spots have all formed crusts, the child is no longer contagious. The whole infection is usually over within a week but sometimes it may be longer.

Treatment of Chickenpox

In chickenpox no drug treatment is necessary in the vast majority of people. The symptoms may be eased with paracetamol if a high temperature is present and warm salt baths may be comforting. Calamine lotion may sooth the itchiness. If the spots become infected, an antiseptic ointment may be used. In children whose resistance to infection is impaired acyclovir (Zovirax) may reduce the development of complications.

Shingles

Shingles (herpes zoster) and chickenpox (varicella) are caused by the same virus (varicella-zoster virus) which spreads by droplets from the nose and mouth and from contact with chickenpox sores.

Shingles is caused by an invasion of the roots of nerves by the varicella-zoster virus. It causes pain, blisters and sores in the area of skin supplied by the nerve. An attack of shingles results from a reactivation of the chickenpox/shingles virus that has lain dormant for months or years. The frequency and severity of shingles increases with age, and in the elderly medical attention should be sought. It can be very severe in people with immune deficiency whose resistance to infection is impaired by drug treatment or disease and will require to be treated by their doctor.

Treatment of Shingles

There is no specific treatment for the rash of shingles but calamine lotion may soothe it. The pain may be relieved by a mild pain reliever such as paracetamol but sometimes it can be very severe and persistent and needs a stronger pain reliever which can be got on prescription.  Other prescription medicines include tricyclic antidepressants (e.g. amitriptyline) which may occasionally relieve the pain. Idoxuridine applied to the rash may possibly help and acyclovir (or another antiviral) by mouth may reduce the duration of pain and the risk of continuing pain in the nerve after the rash has cleared up (post herpetic neuralgia).

Shingles affecting the eye

When shingles affects the nerve that supplies the surface of the eye, it may cause ulcers of the cornea. These produce scaring, blurring of vision and other problems if not treated. They should always be treated urgently by an eye specialist. Anti-viral preparations used to treat shingles of the eye include idoxuridine eye drops and vidarabine ointment which are available only on prescription.