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Chickenpox - Management
How should I symptomatically treat a pregnant woman with chickenpox?

  • Offer paracetamol 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 chlorphenamine may be used during pregnancy for the treatment of allergic conditions [Schaefer et al, 2007], CKS found no evidence to support its use in pregnant women with chickenpox.
    • No increased teratogenic risk has been reported in pregnancies exposed to chlorphenamine [Schaefer et al, 2007]. Although two cohort studies observed no increase in the frequency of congenital anomalies among more than 275 infants born to women who took chlorphenamine during the first trimester of pregnancy [NTIS, 2002], it is generally advised that drugs should be avoided if possible during the first trimester [BNF 54, 2007].
    • The manufacturer of chlorphenamine warns there is inadequate evidence of safety in human pregnancy and use during the third trimester may result in reactions in neonates [ABPI Medicines Compendium, 2005a; ABPI Medicines Compendium, 2005b]. The manufacturer advises using the drug when the potential benefits outweigh the potential unknown risks to the fetus.

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