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Chickenpox - Management
View full scenario
How should I manage a woman with chickenpox who is breastfeeding?
- Offer symptomatic treatment.
- Consider prescribing aciclovir if the woman presents within 24 hours of the onset of the rash (particularly if severe chickenpox or risk of complications).
- Seek urgent specialist advice regarding whether the mother should continue to breastfeed if she has chickenpox.
- Give advice about contact with other people and when to seek medical advice.
- Admit to hospital if serious complications (e.g. pneumonia, encephalitis) are suspected.
- Notify the relevant authorities if in Scotland or Northern Ireland (chickenpox is not a notifiable disease in England or Wales).
In depth
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.
In depth
What advice should I give to someone with chickenpox?
- Advise the following simple measures:
- Encourage adequate fluid intake.
- Dress appropriately to avoid shivering or overheating.
- Wear smooth, cotton fabrics.
- Keep nails short to minimize damage from scratching.
- Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions have crusted over (commonly about 5–6 days after onset of illness):
- During this time, advise a person with chickenpox to avoid contact with:
- People who are immunocompromised (e.g. those receiving cancer treatment or high doses of oral steroids, or those with conditions that reduce immunity).
- Pregnant women.
- Infants aged 4 weeks or less.
- Children with chickenpox should be kept away from school or nursery for 5 days from the onset of the rash.
- Air travel is not allowed until 6 days after the last spot has appeared.
- Inform the person to seek urgent medical advice if their condition deteriorates or they develop symptoms of complications (e.g. cough, shortness of breath, decreased consciousness). Particularly advise parents of young children to be aware of:
- Bacterial superinfection — typically presents suddenly with a high temperature (often after initial improvement), redness and tenderness surrounding the original chickenpox lesions.
- Dehydration — encourage and monitor fluid intake and seek medical attention if signs of dehydration develop (e.g. reduced urine output, lethargy, cold peripheries, reduced skin turgor).
In depth
Prescriptions
Analgesia/antipyretic: when required
Age from 12 years onwards
Paracetamol tablets: 500mg to 1g up to four times a day
Paracetamol 500mg tablets
Take one or two tablets every 4 to 6 hours when required for relief of pain or high temperature. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 200mg to 400mg three to four times a day
Ibuprofen 200mg tablets
Take one or two tablets 3 to 4 times a day when required for relief of pain or high temperature. Do not exceed the stated dose.
Supply 56 tablets.
Calamine lotion
Age from 12 years onwards
Calamine lotion
Apply to the affected area(s) when required to relieve itching.
Supply 400 ml.
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