Chickenpox: an elusive childhood disease surfacing in adulthood as shingles

Nutrition Health Review, Spring, 1993 by Dodi Shultz

A number of the classic "childhood diseases" -- so called because they inevitably struck each new generation of youngsters -- are now unfamiliar to most Americans. Today, polio, rubella, diphtheria, pertussis (whooping cough), and measles are preventable by timely vaccination.

But there's one major exception: chicken-pox -- or, as it's known medically, varicella (a diminutive of "variola," the technical term for smallpox). Some 3.5 million Americans, mostly children, come down with this viral illness each year.

Fortunately, the disease, while highly contagious, is generally mild and, normally, not life-threatening. Some individuals, however, are at higher risk for serious illness; according to the American Academy of Pediatrics (AAP), there are more than 4,500 hospitalizations for chickenpox annually, with 50 to 100 deaths. Recently, the Food and Drug Administration has approved the use of some products to lessen the impact of the illness.

The Usual Course

Varicella occurs chiefly, though not exclusively, in early spring and often spreads rapidly through families, neighborhoods, and such sites as day-care centers. Three- to 6-year-olds who have started school or preschool and have begun to socialize with other children are most vulnerable, although anyone of any age who has never had the disease is susceptible.

After a 10- to 20-day incubation period (the time between exposure to the virus and the onset of illness), an infected youngster begins to feel draggy and usually runs a low fever; uncommonly, the fever may be high or, occasionally, there's none at all. Within a day or two, a characteristic rash appears, often first on the back, chest, or scalp and gradually spreading to the rest of the body over three or four days, during which the fever abates. The tiny pimple-like eruptions eventually turn into small blisters and form crusts, which fall away. About a week elapses from start to finish.

In this normal course, the disease is not a serious health threat. The rash, however, can be intensely itchy and, since scratching can lead to secondary infection by bacteria on the skin, such as staphylococcus ("staph"), doctors advise parents to cut youngsters' nails very short and do everything possible to relieve the itch. Calamine lotion may be helpful; so may immersing the child in a cornstarch or baking-soda bath. As the crusty scabs form, the itching subsides. At that point, it's wise to keep the child occupied, since idle hands may turn to picking at the scabs, causing scarring.

No other treatment is necessary. If, however, the child complains of headache, fever, or general malaise, a non-aspirin pain reliever and fever reducer can alleviate discomfort.

Chickenpox can be transmitted to others through fluid from broken blisters, as well as by droplet infection -- coughing or sneezing. A child is contagious from the day before the rash appears until the lesions have all crusted over. The AAP advises that a child who has had chickenpox can go back to school six days after the onset of the rash -- or even sooner, if all the lesions are crusted over.

Although it occurs far less often, a child can also catch chickenpox from an adult with a different condition -- by contact with the lesions on the skin of a person with shingles. Shingles, which involves a painful, rather than itchy, localized eruption following nerve pathways, may develop in a person who has had chickenpox when the virus, which has remained latent in the body, is reactivated; usually, this happens in older people whose immune systems operate less efficiently. The virus that causes both chickenpox and shingles is known medically as the varicella-zoster virus (VZV).

Help for High-Risk Kids

Although chickenpox represents nothing more than temporary discomfort for most children, it can pose more serious problems for children who are immunocompromised -- a medical term describing those whose immune systems are not working normally. In such children, varicella can even be life-threatening, since under these circumstances it can progress to pancreatitis, hepatitis, encephalitis (inflammations of the pancreas, liver and brain, respectively), or pneumonia.

Still another group of youngsters who may be at increased risk are those taking long-term or high-dose corticosteriods for such chronic conditions as asthma or arthritis. (This refers to steroids that are either inhaled, taken orally, or injected, not to topical medications applied to the skin.) These drugs include prednisone, prednisolone, methylpredinisolone, dexamethasone, triamcinolene, and others. They suppress the immune system to a certain extent, so that children taking them may be at higher risk for complications if they come down with chickenpox.

FDA warned of this risk but stressed that stopping the drugs without medical consultation could be "very dangerous." Cortico-steroids may themselves be lifesaving. And since they disrupt the body's normal hormone production system, even when stopping therapy is considered advisable, they are not withdrawn abruptly but tapered off under medical supervision.