• Urgently seek specialist advice regarding the need for diagnostic tests, counselling on the risk of fetal varicella syndrome, antiviral treatment, and follow up:
• Only prescribe an antiviral drug in primary care (with the informed consent of the woman) on the advice of a specialist.
• Offer symptomatic treatment.
• Give advice about contact with other people and when to seek medical advice.
• Monitor the woman closely (review daily, or earlier if her condition deteriorates).
• Refer for urgent hospital assessment if fever persists, or cropping of the rash continues after 6 days.
• Admit to hospital (preferably somewhere with access to specialists in obstetrics, infectious diseases, and paediatrics) if the woman has chest symptoms, neurological symptoms other than headache, haemorrhagic rash or bleeding, severe disease (e.g. dense rash with or without numerous mucosal lesions), or significant immunosuppression.
• Seek specialist advice from the local obstetric unit (even in the absence of complications) if monitoring will be difficult; the woman is in the latter half of pregnancy; or the woman has a complicated obstetric history, history of smoking, chronic lung disease, or poor social circumstances, or is taking steroids.
• Notify the relevant authorities if in Scotland or Northern Ireland (chickenpox is not a notifiable disease in England or Wales).

In depth

• Offer paracetamol to relieve pain or fever. Ibuprofen may be considered but it should not be used beyond 27 weeks of gestation.
• Consider the use of topical calamine lotion to alleviate itch.

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