Chickenpox Patient Return to Public Activities
Yes, a patient with chickenpox who has had lesions for over a week with almost all lesions dried up can go out now, provided ALL lesions are completely dried and crusted with no new lesions appearing. 1
Key Criteria for Ending Isolation
The patient can safely return to public activities when:
- All lesions have completely dried and crusted - this is the critical clinical endpoint for ending contagiousness 1, 2
- No new lesions have appeared within a 24-hour period (for atypical presentations where lesions don't crust) 1, 2
- Typical timeline is 4-7 days after rash onset, which aligns with this patient's "more than a week" timeframe 2
Verification Before Clearance
Before allowing the patient to go out, confirm:
- Inspect all lesion sites to ensure every single lesion has formed a dry crust 1
- Check for any moist, weeping, or fluid-filled lesions - even one uncrusted lesion means the patient remains contagious 2
- Verify no new lesions have formed in the past 24 hours 1, 2
The phrase "almost all lesions have dried up" is concerning - if even a few lesions remain uncrusted, the patient is still infectious and should not go out yet.
Infectivity Timeline
Understanding the contagious period helps contextualize this decision:
- Patients are contagious from 1-2 days before rash onset until all lesions crust 2
- Peak infectivity occurs during the vesicular stage when lesions contain active viral particles 2
- Infectivity definitively ends only when ALL lesions are completely dried and crusted 1, 2
Special Precautions Even After Clearance
Once fully cleared (all lesions crusted), the patient should still:
- Avoid high-risk individuals for an additional 24-48 hours including pregnant women, immunocompromised persons, and neonates as a safety margin 2
- Practice meticulous hand hygiene 3
- Avoid sharing towels or personal items for several more days 3
Common Pitfall to Avoid
Do not clear the patient based on "almost all" lesions being dried - this is the most critical error. Even a single uncrusted lesion contains active virus and maintains contagiousness. The standard is 100% of lesions crusted, not "almost all." 1, 2