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Chickenpox - Management
How should I symptomatically treat an immunocompromised person with chickenpox?

  • Offer paracetamol or ibuprofen to relieve pain or fever:
    • The use of antipyretic agents should be considered in children with fever who appear distressed or unwell. Antipyretic agents should not routinely be used with the sole aim of reducing body temperature in children with fever who are otherwise well. The views and wishes of parents and carers should be taken into consideration.
    • For further information, see Paracetamol/ibuprofen issues.
  • Consider the use of topical calamine lotion to alleviate itch.
  • Chlorphenamine may be useful for itch associated with chickenpox for children aged 1 year and above.
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; NICE, 2007a; 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].
  • CKS could not find any evidence to justify the use of topical crotamiton and colloidal oatmeal bath additives in chickenpox.
  • Antihistamines:
    • There is very limited evidence to support the use of topical or systemic antihistamines in relieving pruritus in those with chickenpox. Expert opinion is divided, but some experts find chlorphenamine useful from clinical experience. Piriton®, but not generic chlorphenamine, is licensed for the symptomatic relief of itching due to chickenpox.
    • In a literature review, only one randomized trial was found that investigated the effect of antihistamine in chickenpox [Tebruegge et al, 2006]:
      • Dimetindene (a sedating antihistamine unavailable in UK) was found to be more effective than placebo in reducing itching severity scores, with some improvement in sleep disturbance and appetite [Englisch and Bauer, 1997].
      • However, the study design was poor, as neither the method of randomization nor the blinding process was described [Tebruegge et al, 2006]. The differences in itching severity scores between the groups were small and of uncertain clinical value. The trial was undertaken by the manufacturer of dimetindene in Germany.
      • CKS could not identify any other randomized trials on the effect of antihistamines (including chlorphenamine) in people with chickenpox.
    • Evidence of harm:

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