What is the treatment for chicken pox?

Treatment for Chicken Pox

The standard treatment for chicken pox includes oral acyclovir 800 mg 4 times daily for 5 days for adults and children over 40 kg, or 20 mg/kg 4 times daily for 5 days for children under 40 kg, along with symptomatic management including acetaminophen for fever, topical calamine lotion for itching, and antihistamines for severe pruritus. 1, 2

Diagnosis

Chicken pox (varicella) is characterized by:

• Pruritic vesicular rash appearing in crops
• Lesions in different stages of development simultaneously
• Distribution primarily on face, scalp, trunk, and proximal extremities
• Associated symptoms: fever, malaise, headache, and pruritus 1

Treatment Algorithm

Antiviral Therapy

1. Oral Acyclovir:

   • Adults and children >40 kg: 800 mg 4 times daily for 5 days 2
   • Children (2 years and older): 20 mg/kg 4 times daily for 5 days 2
   • Most effective when started within 24 hours of rash onset 3

2. Intravenous Acyclovir (for severe cases):

   • Indicated for immunocompromised patients
   • Recommended for varicella pneumonia or other complications 4
   • Dosage adjustment required for patients with renal impairment 2

Symptomatic Relief

• Fever and discomfort: Acetaminophen (avoid NSAIDs due to risk of severe bacterial skin infections) 1
• Itching:
  • Topical calamine lotion
  • Colloidal oatmeal baths
  • Oral antihistamines for severe pruritus 1

Special Populations

High-Risk Patients

• Immunocompromised individuals:

  • Require intravenous acyclovir
  • Need close monitoring for complications 1, 5

• Pregnant women:

  • Require specialized care
  • Higher risk of complications 1

• Adults and adolescents:

  • More likely to develop severe disease than children
  • Should receive antiviral therapy even with mild disease 6, 3

Post-Exposure Prophylaxis

• Varicella-zoster immune globulin (VZIG):

  • Recommended for susceptible high-risk individuals within 96 hours of exposure 1, 7
  • Particularly important for immunocompromised patients, pregnant women, and neonates 7

• Varicella vaccination:

  • Can be given within 3-5 days of exposure to prevent or attenuate disease in healthy individuals 1
  • Contraindicated in immunocompromised patients 7

Isolation Precautions

• Isolate patient until all lesions have crusted over (typically 5-7 days after rash onset)
• Avoid contact with:
  • Pregnant women without immunity to varicella
  • Newborns and infants
  • Immunocompromised individuals
  • Individuals without history of chickenpox or vaccination 1

When to Seek Immediate Care

Advise patients to seek immediate medical attention for:

• Rash involving the eyes
• Signs of secondary bacterial infection
• Severe headache
• Persistent high fever
• Shortness of breath or chest pain 1

Treatment Efficacy

Early treatment with acyclovir (within 24 hours of rash onset) has been shown to:

• Decrease the number of lesions
• Shorten the duration of new lesion formation
• Reduce systemic symptoms
• Decrease complications 8, 3

The benefit of antiviral therapy diminishes significantly if started more than 24 hours after rash onset, though it may still provide some benefit if started within 72 hours 3.