Varicella is a highly contagious viral infection caused due to the varicella-zoster virus (VZV). It is also known as chickenpox. 

This virus belongs to the herpesvirus family, and it causes herpes zosters later in life. 

Varicella easily spreads through respiratory droplets when an infected person coughs or sneezes and with direct contact. 

Dr. Michiaki Takahashi created varicella vaccine in 1970s. It is first licensed in 1986 in Japan. 

Shingles causes a painful localized rash to affect one side of the body or face. VZV infection causes herpes zoster later in life for those with weakened immune systems.  

The varicella vaccine is the most effective option to prevent varicella.  

It is given in two doses as: 

First dose at 12 to 15 months of age  

Second dose at 4 to 6 years of age 

Varicella incidence is reduced in countries with high vaccination rates that lead to fewer severe cases and complications post-vaccine introduction.  

It is a highly contagious virus with over 90% infection rate. Varicella patients are contagious 1 to 2 days before rash to 5-7 days after crusted lesions appear.  

>90% of susceptible individuals in households become infected with varicella after exposure due to high rate. All varicella cases occurred in children aged 1 to 9 years old with peak incidence between 4 to 6 years old. 

Before the discovery of vaccine, varicella caused around 100 to 150 deaths every year in the United States. 

VZV enters the body through respiratory tract or direct contact with fluid from varicella vesicles. A virus enters bloodstream and spreads throughout the body during primary viremia period. 

The virus replicates in organs, then spreads through secondary viremia to skin and mucous membranes. 

Activation of macrophages, natural killer cells, and cytokine release control viral replication in immunity. B-cells make antibodies to neutralize and clear VZV virus from body. 

Varicella-zoster virus can reactivate when immune system is weak to cause herpes zoster rash through sensory nerves. 

The causes of varicella are:  

• Varicella-Zoster Virus 
• Respiratory Droplets 
• Direct Contact 
• Initial Replication 
• Age of host 
• Immune and Vaccination Status of host 
• Geographic and Environmental Factors 

Immunocompromised individuals face increased risk of severe varicella complications. Varicella is usually mild and favourable in healthy children. 

Unvaccinated high-risk individuals face increased risk of severe disease and complications in pregnant women and the immunocompromised. 

Contracting varicella in early pregnancy carries a risk of congenital varicella syndrome and fetal abnormalities. 

Breakthrough varicella is milder with fewer lesions and complications. 

Detailed information including initial exposure and incubation period along with rash development of patient should be gathered. 

• Respiratory System 
• Cardiovascular System 
• Skin Examination 
• Abdominal Examination 

Symptoms of Prodromal Phase are: 

• Fever 
• Malaise 
• Headache and Myalgia 
• Anorexia 

Varicella in healthy children is mild and thus needs only symptomatic treatment. In such cases consider oral acyclovir for high-risk individuals. 

Symptoms in children can be treated with topical and oral remedies to relieve itching and discomfort effectively. 

Acyclovir reduces symptoms and duration of varicella if taken within 24 hours but not used in healthy children. 

Acyclovir IV therapy is recommended for immunocompromised patients at risk of severe varicella complications. 

Complications from bacterial infection of skin lesions more severe in immunocompromised individuals. 

Milder presentation than primary varicella with atypical symptoms like few papules but can still progress to severe pneumonitis. 

Varicella-zoster immune globulin given within 10 days of exposure can modify the course of disease but does not prevent it. 

Vaccine-related shingles seen in both healthy and weakened immune systems. 

Dermatology, General

Isolate infected individuals until lesions have crusted for high-risk groups. 

Children with varicella should stay home until all lesions have crusted usually around 7 days after rash begins. 

Ventilate room with fans or open windows to disperse viral particles and lower risk of airborne transmission. 

Patient should daily wash their hands with soap and water. Infected person’s linens, clothes, and towels should be clean in hot water with dryer on high heat. 

Proper awareness about varicella should be provided and its related causes with management strategies. 

Appointments with a dermatologist and preventing recurrence of disorder is an ongoing life-long effort. 

Dermatology, General

Varicella zoster immune globulin, human: 

In passive immunization cases it is indicated for use in highly susceptible and VZV-exposed immunocompromised patients. 

Dermatology, General

Acyclovir: 

It inhibits activity of HSV-1 and HSV-2. Their affinity for viral thymidine kinase causes DNA chain termination. 

Famciclovir: 

It converts into active antiviral agent called penciclovir to inhibit viral deoxyribonucleic acid synthesis or replication. 

Dermatology, General

Diphenhydramine: 

It binds to H1 receptors in the CNS with anticholinergic effects in the body. 

Loratadine: 

It inhibits peripheral histamine H1-receptors. It has decreased incidence of sedation thus used to relieve pruritus. 

Dermatology, General

Interventions involved for varicella are focused on managing complications, providing supportive care, or addressing severe cases. 

Dermatology, General

In Pre-Exposure phase, make sure children receive the varicella vaccine as part of their routine immunizations. 

In exposure phase, determine if exposed individuals are immune through past infection or vaccination history. 

Pharmacologic therapy is effective in the treatment phase as it includes use of antivirals and antihistamines. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and therapies. 

The regular follow-up visits with the dermatologist are scheduled to check the improvement of patients along with treatment response.