Chickenpox: A Complete Overview

Medically Reviewed By Elizabeth Thottacherry, MD
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Chickenpox is a disease that is a result of infection by the varicella-zoster virus. Chickenpox is highly contagious and can potentially cause serious illness. While chickenpox used to be very common in the United States, vaccination has reduced rates of transmission and complications. Many people believe chickenpox to be a mild childhood disease because it commonly occurs in people under the age of 15. Most children without vaccination catch the disease, and many people have had the disease and recovered.

However, chickenpox presents a risk of severe illness and further complications to all. This is especially possible for young infants, adolescents, adults, pregnant people, and people who have weakened immune systems.

This article will explain what chickenpox is, including information about its symptoms, risks, treatment, vaccination, and more.

What is chickenpox?

A parent applies ointment to a child's chickenpox spots.
Liliya Rodnikova/Stocksy United

Chickenpox is a disease caused by the varicella-zoster virus. Chickenpox is highly contagious and can spread from one person to another easily.

The most common symptom of chickenpox is the development of itchy blisters all over the body. However, not all cases of chickenpox present the same degree of symptoms.

Now that a vaccine is available, there is a lower risk of getting ill or experiencing serious complications from chickenpox.

After infection from the virus, the virus can spread to lesions on some sensory nerves, causing illness and chickenpox symptoms. After recovery, the virus remains dormant in the sensory nerves. While the immune system may control this latent virus, sometimes the virus reactivates later in life and causes shingles.

Learn more about shingles here.

‘Chickenpox parties’ are not safe or recommendable.

According to the Centers for Disease Control and Prevention (CDC), “chickenpox parties,” deliberate exposure to people with chickenpox, are unsafe.

Some people have intentionally exposed their children to chickenpox to have them get the disease at that time and prevent more severe illness in adulthood.

However, the CDC strongly discourages this. Chickenpox at any age can cause very serious illness, severe complications, and even be fatal.

There is no guarantee that anyone, including a child, will experience mild symptoms, and the risk of complications remains. Additionally, while less likely, it is possible to be ill with chickenpox even after childhood or previous infection.

The best protection against chickenpox remains vaccination.

What are the symptoms of chickenpox?

Symptoms can vary in intensity among individuals.

Some people experience a mild course of chickenpox. They develop only a small number of blisters and have few, if any, other symptoms. This is particularly true for those who get the infection despite having been vaccinated, which is uncommon but possible. Other people experience more extensive blistering and flu-like symptoms.

Adults may also experience more severe symptoms, having a high temperature for longer and developing more spots than children might.

Symptoms mostly develop within 10–21 days after exposure. However, the disease becomes contagious 1–2 days before a rash appears. Chickenpox remains contagious until the blisters have crusted over.

Chickenpox rash

The classic symptom of chickenpox is the rash that can occur.

A chickenpox rash typically develops fluid-filled blisters that can be very itchy. These blisters or lesions eventually turn into dry scabs.

The rash can appear anywhere, but it often appears first on the chest, back, stomach, pelvis, and face. The rash may then spread around the whole body. It can affect the skin inside the mouth, on the eyelids, or in the genital area.

Other symptoms can start before the onset of the rash and accompany the rash once it develops.

Chickenpox rashes can appear in three stages. However, new spots can develop while earlier spots move into the following stages. Therefore, it is possible to experience a rash exhibiting all three stages at once.

These stages include:

  • Stage 1: Small spots that may resemble pimples develop. These spots can appear raised, flushed in color, red, or pink. The spots may also appear darker or similar in color to the surrounding skin. The spots may be more difficult to see on darker skin tones.
  • Stage 2: The small spots develop into blisters or ulcers. Blisters fill with fluid and can cause the rash to itch. These blisters may burst and leak fluid. This fluid is contagious.
  • Stage 3: The blisters dry out into scabs or crust over. Scabs can be flaky or still leak fluid.

Other common symptoms of chickenpox

Some symptoms that are typical of chickenpox may appear 1–2 days before any rash appears.

These common symptoms of chickenpox can include:

Serious symptoms that might indicate a life threatening condition

In some people, the varicella-zoster virus may spread to the brain or lungs.

Other people may develop secondary infections while they have chickenpox, which can affect other areas of the body. Some complications can develop into life threatening conditions. 

Seek immediate medical care or call 911 for anyone experiencing symptoms including:

  • a change in level of consciousness or alertness, such as passing out or unresponsiveness
  • sudden changes in behavior, such as confusion, hallucinations, delusions, and delirium
  • garbled or slurred speech, difficulty or inability to speak
  • a fever of 101oF (38oC) or higher
  • not producing any urine, or an infant who does not produce the usual amount of wet diapers
  • respiratory or breathing problems
  • seizure
  • severe dizziness or sudden loss of balance
  • severe headache
  • symptoms of meningitis

To make it easier to monitor changes to skin color on brown and black skin, check the soles of the feet, the palms, the insides of the eyelids, or the lips and tongue.

Pictures

Below are some examples of what chickenpox rashes can look like at different stages.

Chickenpox,On,The,Face

A chickenpox rash has three stages of development: initial spots, fluid-filled blisters, and scabbed or crusted spots.

Thitisan/Shutterstock

chickenpox-1.jpg

A chickenpox rash has fluid-filled blisters and red, flushed spots. This image shows some blisters at stage 2 of rash development.

Grook da oger, CC BY-SA 4.0, via Wikimedia Commons

Boy,With,Chicken,Pox

A chickenpox rash can appear over the chest and arms. Chickenpox blisters are fluid-filled and can crust over.

ANA VANESA GARCIA NARANJO/Shutterstock

Close-Up Of Shirtless Child With Chickenpox

These fluid-filled blisters typically occur in stage 2 of the rash.

Paulo Sousa/EyeEm/Getty Images

Original Title: C-101438

A chickenpox rash can appear on the legs. These chickenpox-related blisters are fluid-filled and appear darker than the surrounding skin.

John Noble, Jr., MD, 1968/CDC

What causes chickenpox?

Chickenpox is a highly contagious infection caused by the varicella-zoster virus.

Chickenpox is often contagious before the telltale blisters appear, and it can spread without direct contact. Therefore, it is difficult to avoid exposure to chickenpox. The CDC suggests that up to 90% of people with no immunity to chickenpox may acquire the disease if they are close to a person who has it.

Chickenpox can be spread directly through person-to-person contact and indirectly through the air. This happens as infectious droplets and aerosolized virus in coughs or sneezes pass through or remain in the air. A person who then breathes in, touches, or collects airborne viral particles on the mucous membranes may acquire the infection.

Additionally, close contact with people who have shingles can transmit chickenpox. People with shingles are contagious with the same varicella-zoster virus.

Read here for more information about how shingles and chickenpox relate.

How do you reduce the risk of chickenpox?

To lower your risk of developing chickenpox:

  • avoid contact with people who have the disease or have had recent exposure to it
  • get vaccinated against varicella-zoster virus with two doses
  • get a chickenpox vaccine within 3–5 days after exposure if you do not have immunity
  • wash your hands well with soap and water after having contact with a person with chickenpox

There are two chickenpox vaccines available in the U.S., Varivax and ProQuad. Two doses of a vaccine can be effective, reducing the risk of hospitalization and death.

Contact your doctor to discuss vaccination.

Reducing the risk of transmitting chickenpox

To reduce the risk of transmitting chickenpox to others:

  • avoid scratching the rash or blisters to reduce contamination from the blister fluid
  • keep your nails trimmed, and put mittens on infants’ and toddlers’ hands
  • wash your hands well and regularly
  • keep children with chickenpox home from school, day care, and away from others until all the spots have crusted over
  • stay home from work and away from others until the spots have crusted over

How do you treat chickenpox?

For those who develop chickenpox, the goal of treatment is to relieve symptoms and prevent complications.

A doctor may prescribe antiviral medications to lower the risk of complications. To be most effective, antiviral treatments need to be started early in the course of the infection.

If you present symptoms of complications or secondary illness, your doctor will work with you to diagnose and treat them.

At-home care for chickenpox

Follow your doctor’s instructions and take all medications exactly as prescribed. In addition, to alleviate your symptoms and decrease your risk of complications:

  • apply anti-itch lotions, such as calamine
  • avoid scratching the blisters and sores
  • avoid sunlight and sunburn
  • drink plenty of water
  • rest
  • take lukewarm oatmeal baths to soothe the skin
  • take oral antihistamine medications
  • take over-the-counter pain relief medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
  • wash your hands frequently
  • wear clothes that are clean, dry, and loose fitting

It is important to remember that pain relief medication may not help alleviate fever. In addition, it is not safe to take too much pain reliever in a day. For example, you should not exceed 4 grams (g) of acetaminophen or 3.2 g of ibuprofen per day, especially if the medications do not help your symptoms.

Aspirin is not an appropriate medication for children.

What are the potential complications of chickenpox?

Chickenpox can cause serious infections and further complications. People who are most at risk include:

  • young infants
  • adults
  • pregnant people
  • people with weakened immune systems
  • people taking medications such as immunosuppressants or chemotherapy, or steroids long term

Additionally, pregnant people with weakened immune systems and people who are immunocompromised have a higher risk of mortality.

Some older adults, including those who previously had chickenpox as a child, are also at risk of reinfection and more serious illness.

Rarely, the viral chickenpox infection can spread to other areas of the body, such as the brain or lungs, resulting in more severe illness and complications. In some people, these complications of chickenpox can be severe or even life threatening.

To minimize risk of serious complications, follow the treatment plan you and your doctor design.

Complications of chickenpox can include:

Other frequently asked questions

Here are questions people also ask about chickenpox. Elizabeth Thottacherry, M.D., an infectious disease and internal medicine clinician, provides answers.

Can you get chickenpox twice?

While it is possible, and in rare cases some people do experience repeat chickenpox infections, the risk of getting chickenpox more than once is generally very low. This is because most people develop and maintain immunity for the rest of their lives.

The virus that causes chickenpox can also reactivate and cause shingles.

How long is chickenpox contagious?

Chickenpox is contagious from about 48 hours before the rash appears until all of the rash blisters have crusted over.

However, this timeline is not exact for everyone, and there may be individual variation. Always take care with chickenpox around people at risk of complications.

Does chickenpox still exist in 2022?

Yes, chickenpox does still exist and infect people in 2022.

Is it better to get chickenpox or the vaccine?

It may be better to get the vaccine.

Chickenpox affects people differently, and there is no way to tell how serious an infection a person may get.

Vaccination gives you protection without the risk of a serious disease.

Is it possible to never get chickenpox?

It is possible to never have chickenpox, although this is unlikely, especially without vaccination, as chickenpox is a very transmissible disease.

However, if you have received the vaccine, it is possible that you may not contract chickenpox. You also may not have symptoms or have mild symptoms with a chickenpox infection.

Summary

Chickenpox is a highly contagious disease caused by the varicella-zoster virus. Although many people consider chickenpox to be normal in childhood, it can present significant risks of severe illness and life threatening complications.

Transmission of chickenpox can occur from contact with the rash or rash fluid, or through airborne viral particles. Vaccination is an effective way to reduce the risk of transmission and adverse impacts on health.

Typical symptoms of chickenpox include a rash that blisters and crusts, fever, respiratory symptoms, and malaise.

Contact your doctor for treatment, and seek emergency treatment for any serious symptoms. Your doctor can also help advise you about vaccination.

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Medical Reviewer: Elizabeth Thottacherry, MD
Last Review Date: 2022 Jul 11
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