What is the management of chickenpox in a 12-year-old?

Management of Chickenpox in a 12-Year-Old

For a 12-year-old with chickenpox, the primary management approach is supportive care, as antiviral therapy is not routinely indicated in otherwise healthy children with uncomplicated varicella infection. 1

Assessment and Diagnosis

• Chickenpox (varicella) is characterized by a pruritic vesicular rash that progresses through stages of macules, papules, vesicles, and crusts 1
• Diagnosis is typically clinical based on the characteristic appearance of the rash 1

Supportive Care Measures

• Keep the child isolated until all lesions have crusted over (typically 5-7 days) to prevent transmission 1
• Manage fever with appropriate antipyretics (acetaminophen preferred; avoid aspirin due to risk of Reye syndrome) 1
• Relieve itching with:
  • Lukewarm baths with colloidal oatmeal
  • Calamine lotion applied to lesions
  • Oral antihistamines if itching is severe 1
• Maintain good hydration and nutrition 1
• Keep fingernails short and clean to prevent secondary bacterial infection from scratching 1

Antiviral Therapy Considerations

• Acyclovir is not routinely recommended for healthy 12-year-old children with uncomplicated chickenpox 1
• However, acyclovir may be considered in specific situations:
  • If the child is immunocompromised or receiving immunosuppressive therapy 1
  • If the child has chronic skin or pulmonary disorders 2
  • If treatment can be initiated within 24 hours of rash onset 3, 4

Acyclovir Dosing (if indicated)

• For children over 12 years: 800 mg orally 4 times daily for 5 days 5
• Treatment should ideally be initiated within 24 hours of rash onset for maximum effectiveness 3, 4
• Five days of therapy is sufficient as longer courses provide no additional benefit 4

Prevention of Spread

• Keep the child isolated until all lesions have crusted over (typically 5-7 days) 1
• Susceptible family members who have been exposed may benefit from varicella vaccine if administered within 3-5 days of exposure 1
• Ensure the child receives a second dose of varicella vaccine once fully recovered if they've only had one dose previously 6

Monitoring for Complications

• Watch for signs of secondary bacterial skin infections (increasing redness, warmth, tenderness, or purulent drainage) 3
• Monitor for rare but serious complications such as pneumonia, encephalitis, or cerebellar ataxia 3
• Seek immediate medical attention if the child develops:
  • Persistent high fever
  • Severe headache
  • Difficulty breathing
  • Altered mental status
  • Severe abdominal pain 1

Follow-up

• Most cases resolve without complications within 5-7 days 1
• Routine follow-up is typically not necessary unless complications develop 1
• Ensure the child receives appropriate catch-up vaccination if they haven't completed the two-dose varicella vaccine series 6