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Lara Adejoro
A consultant dermatologist at the University of Ilorin Teaching Hospital, Ilorin, Kwara State, Dr. Omotoyosi Ilesanmi, talks to LARA ADEJORO about the management of chickenpox
What is chickenpox?
Chickenpox is an infectious disease caused by the varicella-zoster virus. It is part of the herpes family group of viruses and it is a highly infectious disease. It is usually transmitted through contact with people who have the disease or through droplets; unaffected people who come in contact with the droplets containing the organism can become infected. It forms a rash on the body.
Can you describe the nature of the rash?
It is usually located in the chest area around the face, and with time, it may spread to the upper or lower limbs. It is a very itchy rash and the incubation period is between 10 to 14 days. When someone gets infected, the person may develop the rash two or three days after the person starts having a headache, fever, and muscle aches and pain. The person becomes generally unwell and develops the rash two or three days later. The rash takes three to seven days, it develops like tiny pimples with water inside. It will usually burst and dry off and usually takes three to seven days. Patients are usually infected before the rash starts appearing.
How does chickenpox affect children?
The other thing about chickenpox disease is that it is usually common among children because they have close contact with people in schools. In children also, it is usually a very mild course and it is not usually severe. However, in some people, it may be severe.
What about adults?
Adults can also have it. Adults who are prone to having it are adults who usually work with children, adults that work in hospitals, healthcare workers and adults that are immunocompromised. Most of the healthcare workers that did not have the disease as children would have contracted it when taking care of patients with chickenpox because it is highly infectious. It is also very common and very serious in those who have immunosuppression like patients who have cancer or are undergoing chemotherapy or those who have undergone a cardiac or renal transplant, or those that have HIV infection, or diabetes. It is also serious when pregnant women have it because it can cause the malformation of the baby, and it has to be treated so that babies do not come out malformed.
It is also very serious when newborns have it. If for instance, a pregnant woman or a newborn baby comes in contact with a person that has chickenpox, and the person does not have immunity against the chickenpox virus, that person has to have immunoglobulin given so that they do not develop a very severe form of the virus; and if the person develops the chickenpox, he has to be treated with antivirals. However, we don’t typically treat children who are not immunocompromised with antivirals, we give them perhaps paracetamol or acetamin to help with the itching, or give them calamine lotion to keep the rash in check because, with constant itching of the rash, the person may develop bacterial infection; so, we try to ensure that they do not scratch as much as possible; we can also give them loratadine to stop the itching.
What makes a person immune to chickenpox?
It is a highly infectious viral disease. If someone has chickenpox in a room, it is very likely for other people in that same room to have it if they are not immune to the virus. A person can be immune to the virus if the person has had chickenpox as a child, but if they didn’t have it as a child and they come in contact with people that have chickenpox, it is very likely that the person will develop chickenpox.
What are the risk factors for the infection?
One is at more risk of developing the infection if they are immunocompromised as mentioned earlier. When we are exposed to diseases, we have our natural immune system that jumps up to our defence, but if one has those conditions I mentioned earlier, one will have a suppression of their immunity and when they are exposed to chickenpox, they are more likely to get the disease and even a severe form of the disease as opposed to people that don’t have their immune suppressed.
Chickenpox is a highly infectious disease whether you are immunocompromised or not. One may contract the disease once one comes in contact with another person that has the disease and the person is highly infectious at that point or they come in contact with the fluid from the blisters, or they hug the person.
What is the place of vaccines in the prevention of chickenpox?
We have chickenpox vaccines and they are optional vaccines. They are not part of the vaccines you usually get during the childhood immunisation schedule. However, at 12 to 15 months, there is the opportunity to have the chickenpox vaccines, and at around three to four years. So, you take the vaccines twice, once at 12 to 15 months and another one at three to four years. If you get that vaccine, you are less likely to develop chickenpox infection if you come in contact with someone with chickenpox disease. However, if you end up developing it, you will have a less severe form of the disease. The advantage of having the vaccination is to help you develop immunity against it and if you eventually are infected, you will get a less severe form of the disease.
Apart from the childhood immunisation schedule, we also advise that if, for instance, you have never had chickenpox or you were not vaccinated as a child and you come in contact with someone that has chickenpox infection and has the rash, it is most likely that you develop the chickenpox. So, to prevent that, you should get the chickenpox vaccination, which is available in most immunisation centres, and you get another dose after 28 days. If you do that, you are less likely to develop the virus even as an adult. If you, however, develop the infection, it will likely be less severe.
What are the other symptoms of the viral infection?
A person with chickenpox may have a loss of appetite and feel generally unwell, and then the rash develops within two to three days. The rashes, which are usually present in the chest, abdomen and face, and continue to spread, are fluid-filled blisters that rupture easily. If the person continues to scratch, they might have rashes in some other places, and scratching the rashes can lead to one having scars. Usually, the rash dries off within three to seven days. The incubation period is 10 to 14 days before the symptoms will start to manifest. It becomes more severe if, before the rash dries off, there is an infection with another bacterial infection; the person may become more ill and we may need to give antibiotics, apart from taking antiviral agents to take care of what we call superimposed infection.
How long does it take for the scars caused by the infection to heal properly?
For some people, it may take years, while it may just take months for some people. It depends on the skin type and it depends on how severe the chickenpox was from the onset. Some people who have chickenpox end up having only two spots, while some people have the spots all over (their bodies). If the person has a superimposed bacterial infection or the person has been scratching the body very seriously, that person will have more scars than the person that doesn’t touch the region where the itching comes from. Usually, we say that the scars of chickenpox do not last like the scars of smallpox, which is an eradicated disease. If you see an elderly person who had smallpox as a child, you will still see some scars on the person.
Some people are quick to suspect monkeypox when they notice some rashes on their skins. Is there a connection between it and chickenpox?
Over the past year, there have been several cases of monkeypox. It is a zoonotic disease transmitted to human beings from animals as opposed to human beings where it is more of a human-to-human transmission. Now, we see monkeypox being transmitted from human to human, but the reason people fear it is because they have almost the same look, but they have differences. Chickenpox is more superficial and there are different stages of involvement of the rash. One may have some parts of the rash with fluids, and some of them drying up. For monkeypox, the stages will come out at the same time and it is usually more painful than chickenpox.
For monkeypox, the lymph nodes are usually enlarged and infected persons would have presented with a sore throat. However, the way to diagnose is to take samples from the lesions to the laboratory for studies to get an accurate result. It may take up to one month for the monkeypox lesions to dry up completely.
What are the complications of chickenpox?
It is usually very mild but one or two per cent of people may develop very severe complications, which are lung infections that can cause pneumonia, which can be life-threatening. The person can have the virus going into the brain, which can give rise to seizures; the person may go into a coma. It is usually more severe and complicated in pregnant women. So, you have to treat the woman on time or the child may come out malformed, like having hearing difficulty, a problem with seeing, meningitis, or stillbirth. It is also severe in neonates, so they have to be given antivirals immediately.
Is chickenpox infection common in certain seasons?
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It usually comes out around the dry and rainy seasons. It’s quite common now. Over the last month, I have seen 10 people with chickenpox. The best way to eradicate diseases that have vaccines is by complete vaccination. There is a need for sensitisation of the public about the disease and the need for complete vaccination.
Are there lifestyle changes or home remedies for managing the disease?
That will be maybe wearing masks and you have to make sure that you eat a balanced diet and drink a lot of water. For the home remedies, for most children, the disease will go away even if you don’t give any antiviral and you can use analgesics if you are in pain. If there is severe itching, you can apply calamine lotion bi-hourly. It is also advised that whoever has it should file their nails short because when scratching the body with long nails, you may develop scars. We also advise that whoever has it should stay at home for at least five days until the rash has peeled off and dried up.
What are the dangers of self-medication?
The danger of self-medicating is that you may misdiagnose your condition; you may think you have chickenpox but it may be monkeypox. The best thing is when you start noticing blisters, you should visit the hospital so that you can be diagnosed and offer the needed remedy. The other thing about self-medication is that you may be using a drug you are not supposed to use. Pregnant women are not vaccinated against chickenpox as it can harm the baby.
How can it be appropriately treated?
To be appropriately treated, you need to visit the hospital when you probably have been feeling ill for a few days to diagnose what is wrong with you and know how to treat it. The first thing we do for those who have immunosuppression is to ask if that person had chickenpox before and if the person did not, then we will test if the person has antibodies to the virus. If the person is negative, that means they don’t have the antibodies and may be treated individually.
Is it true that the only way to be immune to chickenpox is when one has been infected?
That is true in some way, that is natural immunity. Not everybody with chickenpox manifests it. Some people may have contracted it while in the womb and may have developed a natural immunity against the disease.
Is it possible to be infected more than once?
There is another one called herpes zoster, which is higher than chickenpox. It is caused by the same virus and it is usually common in those who have had chickenpox. Once you have chickenpox, the virus doesn’t leave the body; it stays in some nerves in the body. As you grow older, if you get infected with HIV or other diseases that can suppress immunity, that same virus can travel through one part of the skin and cause herpes zoster. So, the rash of herpes zoster is almost the same as chickenpox, but it is a more severe form of the disease because it is very painful, though it stays in one spot.
Some Nigerians consume palm wine as a form of medication for chickenpox. Is it an effective treatment option?
I have never heard of that. Nigeria is an African country and we believe in native medication. People also believe that palm oil is an antidote to everything. Palm oil is an antioxidant, it promotes immunity but it is not true that it will cure chickenpox. Viral infections can only be treated using antiviral drugs.
Does chickenpox have any adverse psychological or social impact on a patient?
Yes. If a patient has chickenpox, they may develop scars and that can have a psychological effect on that person. I’ve not seen a study done in Nigeria to assess the mental health of chickenpox patients, but I’m certain anybody that has scars anywhere will have the psychological effect. For instance, if the patients develop lesions on the leg or hand and they are not able to wear short skirts or move freely, then that will have an effect on them and they may start feeling unaccepted in society or they may be depressed because of their looks.
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