Do adults with chickenpox (varicella) need treatment?

Management of Chickenpox in Adults

Adults with chickenpox should receive antiviral treatment with acyclovir to reduce the risk of complications and improve outcomes. While chickenpox is often mild in children, adults are at higher risk for severe disease and complications.

Risk Assessment for Adults with Chickenpox

Adults with varicella (chickenpox) are at significantly higher risk for complications compared to children:

• Adults over age 34 have 2.3 times higher risk of developing pneumonia 1
• Mortality rate in hospitalized adults can reach 0.5% 1
• Risk factors for severe disease include:
  • Age (older adults at higher risk)
  • Pregnancy
  • Immunocompromised status
  • Presence of cough, profuse rash, or prolonged fever 1

Treatment Recommendations

Antiviral Therapy

• For immunocompetent adults with chickenpox:

  • Oral acyclovir 800 mg 5 times daily for 5-7 days 2
  • Treatment should be initiated as soon as possible, ideally within 24 hours of rash onset 3
  • Early treatment significantly reduces duration of fever, constitutional symptoms, and time to cutaneous healing 3

• For immunocompromised adults or those with severe disease:

  • Intravenous acyclovir is indicated 4
  • Dosing should be adjusted for renal impairment 2

Supportive Care

• Antipyretics for fever control (avoid aspirin due to risk of Reye syndrome)
• Antihistamines for pruritus
• Maintain hydration
• Monitor for signs of secondary bacterial infection

Special Considerations

Pregnant Women

• Varicella during pregnancy carries risk for both mother and fetus
• Pregnant women without immunity who are exposed to varicella should receive VZIG within 96 hours of exposure 5

Immunocompromised Patients

• Higher risk for disseminated disease and mortality
• Require prompt intravenous acyclovir therapy 4
• May benefit from VZIG prophylaxis after exposure if susceptible 5

Monitoring for Complications

Monitor closely for:

• Respiratory symptoms (cough, dyspnea) suggesting pneumonia
• Secondary bacterial skin infections
• Neurological complications
• Hemorrhagic rash

Prevention

• Varicella vaccination is not recommended for treatment of active infection
• For future prevention, susceptible adults should receive varicella vaccine after recovery 5
• Susceptible adults should avoid contact with persons with active chickenpox or herpes zoster 5

Key Clinical Indicators for Hospitalization

Consider hospitalization for adults with:

• Respiratory symptoms or pneumonia
• Hemorrhagic rash
• Neurological complications
• Immunocompromised status
• Pregnancy
• Inability to maintain oral intake

Chickenpox in adults should never be considered a benign disease. The clinical course is typically more severe than in children, with higher rates of complications including pneumonia, which is the most common serious complication 6. Treatment with acyclovir has been shown to be effective and should be initiated promptly to reduce morbidity and prevent potential life-threatening complications.