• Offer symptomatic treatment.
• For immunocompetent adults and adolescents (aged 14 years or older), consider prescribing aciclovir if they present within 24 hours of rash onset, particularly for people with severe chickenpox or those at risk of complications, such as smokers or people using corticosteroids.
• For children, aciclovir is not recommended.
• Give advice about contact with other people and when to seek medical advice.
• If serious complications (such as pneumonia, encephalitis, or dehydration) are suspected, admit to hospital.
• If the person develops a high temperature (particularly after initial improvement) with redness and pain surrounding the chickenpox lesions, consider bacterial superinfection and manage accordingly.
• This may be more common in people with eczema.

In depth

• Offer paracetamol or ibuprofen to relieve pain or fever.
• To relieve itch, consider:
• Topical calamine lotion.
• Chlorphenamine for those who are 1 year of age or older.

In depth

• 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