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Chickenpox - Management
How should I symptomatically treat a woman with chickenpox who is breastfeeding?

  • Offer paracetamol or ibuprofen to relieve pain or fever.
  • Consider the use of topical calamine lotion to alleviate itch.
Basis for recommendation
  • These recommendations are pragmatic advice. Treatment should be directed toward reducing symptoms, such as fever and itchiness [Allen, 2006; Heininger and Seward, 2006; HPA, 2006; Papadopoulos, 2007].
  • Calamine lotion:
    • Calamine lotion is thought to relieve pruritus by evaporating from the skin to induce a cooling effect [Allen, 2006].
    • In a literature review, no published evidence was found to support the use of calamine to alleviate pruritus in chickenpox. However, the authors felt that it has a good safety profile, and anecdotal reports suggest some degree of symptomatic relief [Tebruegge et al, 2006].
    • The safety of calamine lotion during pregnancy and lactation has not been established, but its use during these periods is not considered to constitute a hazard [ABPI Medicines Compendium, 2002].
  • CKS could not find any evidence to justify the use of topical crotamiton and colloidal oatmeal bath additives in chickenpox.
  • Antihistamines:
    • Although the sedating antihistamine chlorphenamine is licensed for relief of itching associated with chickenpox, there is very limited evidence to support the use of topical or systemic antihistamines in relieving pruritus in those with chickenpox.
    • Chlorphenamine may inhibit lactation and may be secreted in breast milk [ABPI Medicines Compendium, 2005a; ABPI Medicines Compendium, 2005b].
    • Given that there is no detailed knowledge about the effect of chlorphenamine on breastfeeding [Schaefer et al, 2007], CKS does not recommend its use in breastfeeding women.

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