Emollient Therapy for Elderly Patients with Chickenpox
For elderly patients with chickenpox, apply high lipid content emollients such as 50% white soft paraffin/liquid paraffin mixture or white soft paraffin ointment at least twice daily to all affected areas to support barrier function, reduce transcutaneous water loss, and encourage re-epithelialization. 1, 2
Primary Emollient Options Available
High Lipid Content Ointments (Preferred for Elderly)
The British Association of Dermatologists specifically recommends ointment-based emollients with high lipid content for elderly patients, as these provide superior occlusion and barrier support 2. Available options include:
- 100% lipid base products: White soft paraffin, yellow soft paraffin 1, 2
- High lipid mixtures: 50% white soft paraffin and 50% liquid paraffin 1, 2
- Proprietary ointments: Emulsifying ointment, Diprobase® ointment, Cetraben®, Hydromol® ointment 1, 2
- Alternative ointment: Ungmentum M® 1
Cream Formulations (If Ointments Not Tolerated)
If the greasy consistency of ointments reduces compliance, cream alternatives include 1, 2:
- Epaderm® cream
- Diprobase® cream
- Hydromol® cream
- Doublebase® gel 1
Lotion Formulations (For Larger Body Areas)
For extensive body surface involvement, lotions may be more practical 1:
- E45 Lotion®
- Aveeno® lotion
- Vaseline Dermacare®
- Dermol® 500 lotion (can be used as soap substitute) 1
Application Protocol
Frequency and Quantity
- Apply emollients at least twice daily, ideally after bathing to maximize skin hydration 2
- Estimated usage for twice-daily application: 200-400 grams per week for adults 1, 2
- For specific body areas per 2 weeks: Face/neck (15-30g), both arms (30-60g), both legs (100g), trunk (100g) 1
Technique for Chickenpox Lesions
When chickenpox blisters are present 1:
- Pierce intact blisters at the base with a sterile needle (bevel facing up) to facilitate drainage
- Leave blister roof in situ to act as biological dressing
- After drainage, apply bland emollient (50% white soft paraffin/liquid paraffin) to affected areas
- Use aseptic technique for dressing changes to prevent infection
Critical Considerations for Elderly Patients
Infection Prevention
Infection and sepsis are significant risks in chickenpox, particularly in elderly patients 1, 3. Daily washing with antibacterial products can decrease colonization 1. If erosions show clinical signs of infection, obtain bacterial and viral swabs and consider systemic antibiotics per local policy 1.
Antiviral Therapy
While not an emollient, elderly patients with chickenpox should receive oral aciclovir 800 mg four times daily for 5 days, initiated within 24 hours of rash onset for maximum efficacy 4. Chickenpox in adults causes severe systemic manifestations with higher mortality rates, particularly in older age groups 3.
Avoid Sedating Products
Never use sedating antihistamines or crotamiton cream in elderly patients due to fall risk and cognitive effects 5. Avoid calamine lotion for elderly skin 5.
Important Pitfalls
- Ointment compliance: Ointments have greasy consistency that some patients find cosmetically unacceptable, which can reduce adherence 2. Patient preference is decisive for long-term compliance 2.
- Renal dosing: If aciclovir is prescribed, adjust dose for renal impairment (common in elderly): for creatinine clearance 10-25 mL/min, reduce to 800 mg every 8 hours; for <10 mL/min, reduce to 800 mg every 12 hours 4
- Pain management: Provide adequate analgesia prior to blister care procedures, as many patients report pain or burning sensation 1
- Barrier nursing: Patients with extensive erosions should be barrier nursed with vigilance for signs of infection 1