Clinical

Chickenpox and Shingles

Also known as varicella zoster virus, chickenpox is often seen in children under eight years of age. Symptoms include an itchy rash (mainly on the chest and back) comprising of spots that resemble blisters. Discomfort is notably worse if the skin is too warm.

Also known as varicella zoster virus, chickenpox is often seen in children under eight years of age. Symptoms include an itchy rash (mainly on the chest and back) comprising of spots that resemble blisters. Discomfort is notably worse if the skin is too warm.

Chickenpox tends to last between 7-21 days. Paracetamol should be given in the case of fever and cooler baths. Calamine lotion is the traditional option for topical use but is drying in nature. Newer cooling gels/sprays are available to reduce itching and limit any potential scarring.

Advise parents to keep their child away from others – especially pregnant women or immunosuppressed individuals. Ibuprofen is no longer advocated as it can make the lesions worse.

Last year, calls were made to introduce a vaccination to prevent thousands of children catching the highly contagious chickenpox each year. The Varivax vaccine is not part of the national childhood immunisation programme at present, despite having been successfully rolled out in other countries.

Both Sinn Féin and Fianna Fáil have called for the vaccination, which is currently available privately, to be rolled out as part of the public system. Sinn Féin health spokesperson Louise O’Reilly said she would support the roll-out of a chickenpox vaccine along with an information and education campaign.

 

Shingles
Herpes zoster (HZ), also known as zoster or shingles, is caused by the reactivation of the varicella zoster
virus. Community pharmacists have the opportunity to play a key role in the early detection and treatment of HZ. By knowing the signs and symptoms of HZ, pharmacists can help their patients identify it and seek immediate treatment. Early identification is critical.

Most people have chickenpox in childhood, but after the illness has gone, the virus remains dormant in the nervous system. The immune system keeps the virus in check, but later in life it can be reactivated and cause shingles.

Shingles usually affects a specific area on either the left or right side of the body. The main symptoms are:
• pain
• a rash, which develops into itchy blisters and then scabs over

It is estimated that about 3 people in every 1,000 have shingles in the UK every year, so the figure for Ireland should be similar, according to the HSE.

Shingles can occur at any age, but is most common in people who are over 50 years of age. Among people who are over 80 years of age, about 11 people in every 1,000 have shingles each year. Shingles is much less common in children.

It is unknown exactly why the shingles virus is reactivated at a later stage in life, but it may be due to having lowered immunity (protection). This may be the result of:
• being older
• being stressed
• a condition that affects your immune system, such as HIV and AIDS

Rash

The shingles rash usually follows several days after the start of the pain. The rash appears on one side of the body and develops on the area of skin that is related to the affected nerve.

Initially, the shingles rash appears as red blotches on the skin, before quickly developing into itchy blisters that are similar in appearance to chickenpox. New blisters may appear for up to a week, but about three days after appearing they become yellowish in colour, flatten and dry out.

Finally, scabs form where the blisters were, which may leave some slight scarring. It usually takes two to four weeks for the rash to completely heal.

There is no cure for shingles, but treatment can help ease symptoms.

 

For those who develop the shingles rash advise:
• Keep the rash as clean and dry as possible. This will reduce the risk of the rash becoming infected with bacteria
• Wear loose-fitting clothing. This may help sufferers feel more comfortable
• Do not use topical (rub-on) antibiotics or plasters (adhesive dressings) as this can slow down the healing process
• Use a non-adherent dressing (a dressing that will not stick to the rash) if they need to cover the blisters, for example to prevent passing the virus to anyone else

Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching. An antihistamine may also be useful for preventing itching at night.

To ease the pain caused by shingles, analgesics may be used such as:
• paracetamol
• non-steroidal anti-inflammatory drugs (NSAIDs)
• opioids
• antidepressants
• anticonvulsants

Chickenpox – When to Refer
For most children, chickenpox is a mild illness that gets better on its own. However, some children can become more seriously ill with chickenpox and need to see a doctor.
Advise referral to a GP if a child develops any abnormal symptoms, such as:
• if the blisters on their skin become infected
• if the child has a pain in their chest or has difficulty breathing

 

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