Referat

Management of Varicella

Adviser :
Prof. dr. Theresia L. SpKK(K)

Presenter :

Aaron Phuah Siow Jon, S.Ked

BAGIAN ILMU KESEHATAN KULIT DAN KELAMIN

RSMH / FK UNSRI
PALEMBANG
2012

Approval Page

Referat :

Has been accepted as a condition of completing Clinical Senior Registrar (KKS) in the
Department of Dermatology Health Science Faculty of Medicine, University of Sriwijaya /
Hospital Dr. Mohammad Hoesin Palembang

Palembang, March 2012

Adviser,

Prof. dr. Theresia L. SpKK(K)

CONTENT
Approval Page...........................................................................................................................2
Introduction...............................................................................................................................4
Epidemiology.............................................................................................................................4
Patofisiology..............................................................................................................................5
Clinical Symptoms.....................................................................................................................5
Supporting Examination............................................................................................................5
Management..............................................................................................................................6
Complication.............................................................................................................................7
Prognosis...................................................................................................................................7
Conclusion.................................................................................................................................7
References.................................................................................................................................8

I. INTRODUCTION
Chickenpox is a viral infection in which a person develops extremely itchy blisters all
over the body. Chickenpox is a highly contagious illness caused by primary infection with varicella
zoster virus (VZV). It usually starts with vesicular skin rash mainly on the body and head rather than
at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring. On
examination, the observer typically finds lesions at various stages of healing.

Chickenpox is an airborne disease that spreads easily through coughing or sneezing of

ill individuals or through direct contact with secretions from the rash. A person with
chickenpox is infectious one to two days before the rash appears. They remain contagious
until all lesions have crusted over (this takes approximately six days). Immunocompromised
patients are contagious during the entire period as new lesions keep appearing. Crusted
lesions are not contagious.
Chickenpox is most common in children under 10. In fact, chickenpox is so common
in childhood that 90% of adults are immune to the condition because they've had it before.1,2

II. EPIDEMIOLOGY
Primary varicella is a disease that is endemic to all countries worldwide. Varicella has
a prevalence that is stable from generation to generation.
In temperate countries, chickenpox is primarily a disease of children, with most cases
occurring during the winter and spring, most likely due to school contact. It is one of the
classic diseases of childhood, with the highest prevalence in the 410 year old age group.
Like rubella, it is uncommon in preschool children. Varicella is highly communicable, with
an infection rate of 90% in close contacts. In temperate countries, most people become
infected before adulthood but 10% of young adults remain susceptible.
In the tropics, chickenpox often occurs in older people and may cause more serious
disease. In adults the pock marks are darker and the scars more prominent than in children.1,3,5

III. PATOFISIOLOGY
Exposure to VZV in a healthy child initiates the production of host immunoglobulin
G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) antibodies; IgG antibodies
persist for life and gives immunity. Cell-mediated immune responses are also important in
limiting the scope and the duration of primary varicella infection. After primary infection,
VZV is hypothesized to spread from mucosal and epidermal lesions to local sensory nerves.
VZV then remains latent in the bodys nerve tissues of the sensory nerves. Reactivation of
VZV results in the clinically distinct syndrome of herpes zoster.3,6,7
III. CLINICAL SYMPTOMS
Most children with chickenpox have the following symptoms before the rash appears:

Fever

Headache

Stomach ache

The chickenpox rash occurs about 10 to 21 days after coming into contact with someone who
had the disease. The average child develops 250 to 500 small, itchy, fluid-filled blisters over
red spots on the skin.

The blisters are usually first seen on the face, middle of the body, or scalp

After a day or two, the blisters become cloudy and then scab. Meanwhile, new blisters
form in groups. They often appear in the mouth, in the vagina, and on the eyelids.

Children with skin problems such as eczema may get thousands of blisters.

Most pox will not leave scars unless they become infected with bacteria from scratching.
Some children who have had the vaccine will still develop a mild case of chickenpox. They
usually recover much more quickly and have only a few pox (less than 30). These cases are
often harder to diagnose. However, these children can still spread chickenpox to others.8,9

IV. SUPPORTING EXAMINATION

Chicken pox can usually be diagnosed by looking at the rash and asking questions
about the person's medical history. Small blisters on the scalp usually confirms the diagnosis.
Laboratory tests like Tzanck Test can help confirm the diagnosis, if needed.1,5

V. MANAGEMENT
Treatment involves keeping the person as comfortable as possible.

Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid damaging
the skin from scratching.

Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool,
over an itchy area.

Take lukewarm baths using little soap and rinse thoroughly to avoid bacterial
infection. Try a skin-soothing oatmeal or cornstarch bath.

Apply a soothing moisturizer after bathing to soften and cool the skin.

Staying in a cold surrounding can help in easing the itching as heat and sweat makes it
worse.

Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be

aware of possible side effects such as drowsiness.

Try over-the-counter hydrocortisone cream (1%) on itchy areas.1,5,6

To work well, the medicine usually must be started within the first 24 hours of the rash.

Antiviral medication may be very important in those who have skin conditions (such
as eczema), lung conditions (such as asthma), or who have recently taken steroids.

If oral acyclovir is started within 24 hours of rash onset, 5-7 days (800 mg x5 daily
adults, 20 mg/kg up to 800 mg q.d.s. for children) it decreases symptoms by one day
but has no effect on complication rates. Use of acyclovir therefore is not currently
recommended for immunocompetent individuals (healthy persons without known
immunodeficiency or children capable of developing an immune response). Children
younger than 12 years old and older than one month are not meant to receive antiviral
medication if they are not suffering from another medical condition which would put
them at risk of developing complications.
Do not give aspirin or ibuprofen to someone who may have chickenpox. Use of

aspirin has been associated with a serious condition called Reyes syndrome. Ibuprofen has
been associated with more severe secondary infections. Acetaminophen (Tylenol) may be
used. A child with chickenpox should not return to school or play with other children until all
chickenpox sores have crusted over or dried out. 1,5,6

VI. COMPLICATION
Rarely, serious bacterial infections such as encephalitis occur. Other complications may
include:

Reye's syndrome

Myocarditis

Pneumonia

Cerebellar ataxia may appear during the recovery phase or later. This involves a very
unsteady walk.

Women who get chickenpox during pregnancy can pass the infection to the developing baby.
Newborns are at risk for severe infection.5

VII. PROGNOSIS
Usually, a person recovers without complications.
Once you have had chickenpox, the virus usually remains dormant or asleep in your body for
your lifetime. About 1 in 10 adults will have shingles/herpes zoster when the virus reemerges during a period of stress.5,7

VIII. CONCLUSION
Chickenpox is a viral infection in which a person develops extremely itchy blisters all
over the body which is caused by varicella zoster virus. Chickenpox is an airborne
disease spread easily through coughing or sneezing of ill individuals or through direct contact
with secretions from the rash. After primary infection, VZV is hypothesized to spread
from mucosal and epidermal lesions to local sensory nerves. VZV then remains latent in
the bodys nerve tissues of the sensory nerves. Reactivation of VZV results in the clinically
distinct syndrome of herpes zoster. Treatment involve keeping the person as comfortable as
possible and avoid scratching. Usually, a person recovers without complications.

REFERENCES
1. Myers MG, Seward JF, LaRussa PS. Varicella-zoster virus. In: Kliegman RM,
Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed.
Philadelphia, Pa: Saunders Elsevier;2007:chap 250.
2. American Academy of Pediatrics Committee on Infectious Diseases. Recommended
immunization

schedules

for

children

and

adolescents--United

States,

2008. Pediatrics. 2008;121:219-220.

3. Rea T H, Modlin R L.Varicella and Herpes Zoster. In: Wolff K, Goldsmith L, Katz S
I, Gilchrest B A, Paller A S, Leffell D, editors. Fitzpatrick's dermatology in general
medicine (two vol. set). 7thed. New York; McGraw-Hill Professional; 2008.
4. Viral Diseases. In: James W D, Berger T G, Elston D M, editors. Andrews disease of
the skin clinical dermatology. 10th ed. Canada: Saunders-Elsevier; 2006. p376-381.
5. Kaneshiro N K. Chicken pox.[online].2011 Feb 8 [cited 2012 Mar 21]. Available
from: URL:
http://www.nlm.nih.gov/medlineplus/ency/article/001592.htm

6. Rull D G. Chickenpox (Varicella) [Online]. [2009] [cited 2012 Mar 21].Available

from URL:
http://www.patient.co.uk/doctor/Chickenpox-(Varicella).htm

7. Bechtel K A. Pediatric Chicken Pox [Online]. [2011 Sept 28] [cited 2012 Mar
12].Available from : URL:
http://emedicine.medscape.com/article/969773-overview
8. Griffing G T. Chicken Pox (Varicella) [Online]. [2010 July 30] [cited 2012 Mar
12].Available from : URL:
http://www.webmd.com/vaccines/tc/chickenpox-varicella-topic-overview

9. Varicella (chickenpox) and Zoster (shingles). In: Burns T, Cox N, Gritfitis C,

Breathnach S, editors. Rooks Textbook of Dermatology. Volumes 1-4. Australia;
Blackwell Science; 2004.p. 25.23-25.36.