What do chicken pox look like when they first come out?

What do chicken pox look like when they first come out?

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 Varicella-zoster virus is a type of virus that is responsible for varicella (chickenpox) and shingles. Chicken pox also known as ‘demam campak’. Shingles are also known as herpes zoster. When they first come out, the chickenpox appears as a vesicular rash which means the rash is spherically containing clear fluid. Varicella vaccine was introduced in 1995 and since then, the number of cases, complications, hospital admissions, and death has come down dramatically. This reflects a strong herd immunity has been formed against this disease. The incidence of varicella is highest from March to May. 

  Before the vaccine introduction, 95% of Americans had varicella before the age of 20. In tropics, varicella commonly affects young adults. Varicella infection in children is a mild disease. It is more severe in adults and among immunocompromised individuals of any age group. This disease is transmitted via direct contact with respiratory droplets or vesicle fluid from the skin lesions. The clinical features of varicella are:

  • Loss of appetite
  • Pharyngitis
  • Fever 
  • Malaise
  • Vesicular rash

 The complications of varicella are:

  • Skin infections
  • Soft-tissue infections
  • Encephalitis
  • Aseptic meningitis
  • Transverse myelitis
  • Vasculitis

 There are eight herpes viruses known to cause infection in humans and varicella is one of them. Antiviral is not needed in children 12 years old and younger with a competent immune system. However, unvaccinated adolescents, pregnant women, adults, and immunocompromised individuals require antiviral therapy. Oral therapy like acyclovir and valacyclovir can be used for immunocompromised individuals without any complications. 

 Others may need intravenous antiviral. Symptomatic treatments like the use of antihistamines, nonsteroidal anti-inflammatory drugs(NSAIDs), and paracetamol are also helpful in the management of this disease. Antihistamines can reduce the itchiness suffered by patients while NSAIDs and paracetamol are effective in managing fever. 

 Vaccination has proven effective in many studies in preventing chickenpox, minimize the severity of chickenpox, minimize the risk of transmission, and reduce the number of herpes zoster in children. Two doses of vaccinations are much better than single-dose vaccines. Vaccination after exposure to varicella minimizes the risk of infection and the development of any complications. Vaccinations are also important for those who are frequently exposed to varicella. Those who are frequently exposed to varicella are:

  • Soldier
  • College students
  • Teachers of young age group
  • Employees of child care
  • International travelers
  • Non-pregnant ladies of childbearing age group


 Immunocompromised individuals may due to:

  • Those who are on chemotherapy
  • Solid tumours
  • Hematological malignancy
  • HIV infection
  • T-lymphocyte deficiency
  • B-lymphocyte deficiency
  • Those who are recipients of solid organs
  • Those who are a recipient of hematopoietic stem cells
  • Patients who are on high dose corticosteroids
  • Untreated active tuberculosis


 Possible side effects following varicella or chickenpox vaccination:

  • Pain
  • Redness
  • Rash
  • Fever
  • Seizure


 Congenital varicella syndrome is a condition in which the infant of an infected mother suffers from a varicella-zoster infection. Acyclovir (an antiviral) and breastfeeding shall be given to cure congenital varicella syndrome. 


  Herpes zoster is a more severe form of varicella-zoster infection in which the skin lesions are atypical and much more serious. In the United States, about 1.2 million individuals are suffering from herpes zoster yearly. Each year, the incidence of herpes zoster keeps increasing. The reason is still unclear and yet no concrete conclusion to explain this phenomenon. The risk factors for developing herpes zoster are:

  • Age 50-59
  • Immunocompromised individuals
  • Those with autoimmune diseases
  • Women
  • HIV infected individuals


 The clinical features of herpes zoster are:

  • Rash
  • Acute neuritis


 The complications of herpes zoster are:

  • Postherpetic neuralgia
  • Herpes zoster ophthalmicus
  • Ramsay hunt syndrome
  • Meningitis
  • Encephalitis
  • Myelitis
  • Guillain-Barre syndrome
  • Stroke syndromes


 One to six percent of individuals will suffer recurrent herpes zoster. As a conclusion, chicken pox is a self limiting and less severe disease in comparison to varicella zoster.





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