Chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:
- Loss of appetite
- Tiredness and a general feeling of being unwell (malaise)
Once the chickenpox rash appears, it goes through three phases:
- Raised pink or red bumps (papules), which break out over several days
- Small fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
- Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.
The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.
When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment and mention you think you or your child has chickenpox, to avoid waiting and possibly infecting others in a waiting room.
Also, be sure to let your doctor know if any of these complications occur:
- The rash spreads to one or both eyes.
- The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
- The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 102 F (38.9 C).
- Anyone in the household is immune deficient or younger than 6 months old.
Chickenpox, which is caused by the varicella-zoster virus, is highly contagious, and it can spread quickly. The virus is transmitted by direct contact with the rash or by droplets dispersed into the air by coughing or sneezing.
Your risk of catching chickenpox is higher if you:
- Haven't had chickenpox
- Haven't been vaccinated for chickenpox
- Work in or attend a school or child care facility
- Live with children
Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. If you've been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever. A few people can get chickenpox more than once, but this is rare.
Chickenpox is normally a mild disease. But it can be serious and can lead to complications or death, especially in high-risk people. Complications include:
- Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis)
- Inflammation of the brain (encephalitis)
- Toxic shock syndrome
- Reye's syndrome for people who take aspirin during chickenpox
Who's at risk?
Those at high risk of having complications from chickenpox include:
- Newborns and infants whose mothers never had chickenpox or the vaccine
- Pregnant women who haven't had chickenpox
- People whose immune systems are impaired by medication, such as chemotherapy, or another disease, such as cancer or HIV
- People who are taking steroid medications for another disease or condition, such as children with asthma
- People taking drugs that suppress their immune systems
Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth or within a couple of days after giving birth. Then it can cause a serious, life-threatening infection in a newborn.
If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.
Chickenpox and shingles
If you've had chickenpox, you're at risk of another disease caused by the varicella-zoster virus called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles — a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.
Shingles can lead to its own complication — a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe.
A shingles vaccine (Zostavax) is available and is recommended for adults age 60 and older who have had chickenpox.