Treatment

Treatment is usually symptomatic in milder disease (1)

• paracetamol can be given to reduce flu like symptoms, fever and pain (2)
• in the home situation, the usual treatment is to bathe the lesions with calamine lotion as an antipruritic.
• the lesions can be bathed with antiseptic solutions like chlorhexidine.

Antivirals

• antivirals should be considered for patients who presents within 24-48 hours of new vesicles (indicating an evolving disease)
• antiviral therapy should be continued for at least 1 week (3)
• oral aciclovir may also be given to
  • immuocompetent adults and older adolescents with chickenpox; aciclovir is not generally indicated for immunocompetent children in whom the disease is milder (1)
  • infants
  • severe infection at any age
  • immunosuppression
  • subjects with severe cardiorespiratory diseas
  • patients with a chronic skin disorder (1)
• aciclovir is not generally indicated for immunocompetent children under the age of 12 in whom the disease is milder (3)
• Public Health England suggest (5):
  • First line for chicken pox and shingles in adults:
    • aciclovir 800mg 5 times daily for 7 days
    • aciclovir dose in children then check BNF

Varicella zoster immune globulin (VZIG)

• VZIG prophylaxis can be used in individuals who complete all of the following criteria:
  • significant exposure to chickenpox or herpes zoster
  • a clinical condition that increases the risk of severe varicella; this includes immunosuppressed patients, neonates and pregnant women
  • no antibodies to VZ virus (4)
• Immunosuppressed patients should be given immunoglobulin to varicella zoster and aciclovir within two days of contact with varicella. If they develop chicken pox they should be treated with aciclovir.

Antibiotics should be given for secondary infections (3).

Key points (5):

• pregnant/immunocompromised/ neonate:
  • seek urgent specialist advice
• chickenpox:
  • consider aciclovir if:
    • onset of rash <24 hours, and 1 of the following:
      • >14 years of age;
      • severe pain;
      • dense/oral rash;
      • taking steroids;
      • smoker
  • give paracetamol for pain relief

Reference:

• (1) Cox NH. Skin infections. J R Coll Physicians Edinb 2008;38:48–52
• (2) Allen S. Chickenpox and shingles infection. Pharmaceutical journal 2006;277(7422):453-456
• (3) Tunbridge AJ et al. Chickenpox in adults - Clinical management. Journal of Infection 2008;57:95e102
• (4) Department of Health 2021. The green book - Varicella
• (5) Public Health England (June 2021). Managing common infections: guidance for primary care