Tuesday, February 20, 2007

Chicken Pox

Dear Lisa,

Can u have chicken pox more than once? i had it as a child but have broken out in sore blistery spots, also my nan has chicken pox which i found out yesterday.

“Chicken Pox Twice?”

Dear “Chicken Pox Twice?”,

Varicella Zoster virus is a herpes virus that causes both Chicken Pox and Shingles. Chicken Pox occurs in 90% of U.S. children before they are 10 years old. (1) Shingles usually occurs in the adult population.

The symptoms of the Chicken Pox include a one to three day prodrome in which the exposed person experiences a fever, respiratory symptoms and a headache. Following this three day period the classic Chicken Pox rash develops. At first the rash appears as red flat lesions which then erupt into dew dropped shaped fluid filled sacs on top of a red base.(1)

The rash is distributed throughout the entire body including the torso, extremities, face, scalp and in some cases the mucosal surfaces(inside the mouth).(1) Chicken Pox lesions can cause intense pruritis (itchiness) and lead a patient to have uncontrollable scratching. Once scratched, the lesions form a scab and once healed may leave scarring. New crops of lesions erupt each day, leaving a patient with a rash consisting of lesions at all different stages.

Once a person contracts Chicken Pox they usually do not get it again. Although, it is possible that an individual can develop Chicken Pox more than once. Studies have shown that the second case of Chicken Pox may be as severe as the first.(2) In particular, children with HIV infection can develop chronic or recurrent Chicken Pox with new lesions appearing for months. (3)

Many people are under the impression that they contracted Chicken Pox twice but in reality one of the episodes represented a different skin condition that looked like the Chicken Pox. Skin conditions that may be mistaken for Chicken Pox include; Coxsackie, Enterocytopathic human orphan, Impetigo, Papular urticaria, Scabies, drug eruption, Contact Dermatitis or Folliculitis.(1)

After a child develops Chicken Pox, the Varicella virus remains dormant or in a resting state in the dorsal root ganglia. The virus can then be reactivated later in life when a person is under stress. This reactivation of the Varicella virus causes Shingles.

When a person develops Shingles they first notice pain, pruritis(itchiness) or numbness on an area of their skin. Soon after this an eruption of grouped vesicles form which remain limited to that area. Typically the rash develops in a band like pattern concentrated in that one area and does not cross the midline of the body. (4) Common places to find the Shingles include the waist, torso or chest.

In rarer cases Shingles can affect the trigeminal nerve which can involve the eye and lead to blindness.(4) Therefore the presence of the Shingles on the face or around the eye warrants immediate medical attention and the expertise of an Ophthalmologist. Immunocompromised patients may develop a generalized rash which spreads throughout their body. (3)

Shingles is expected to occur in 20% of health adults and in 50% of immunocompromised patients.(4) It is most common in people older than fifty and in certain children. Children at risk for developing Shingles include those who contracted Chicken Pox before the age of one, those exposed to the Varicella virus in utero, immunocompromised children, children with Systemic Lupus erythematosus and children suffering from Acute Lymphocytic Leukemia or other malignancies.(5) Individuals who are vaccinated for Varicella are less likely to develop Shingles as compared to individuals who were not vaccinated and contracted live Chicken Pox.(6)

If your rash started with symptoms such as numbness, pain or itchiness and is localized to one area of your body, your condition may actually be a reactivation of the Varicella Virus or Shingles. The only way to determine the cause of your rash is to have it evaluated by a health care professional. In the mean time it would be prudent to cover the rash, avoid skin to skin contact with other people and stay away from immunocompromised individuals and children who are not immunized.

It is important to remember that other conditions can look like Chicken Pox, therefore it is essential that you seek medical attention in order to get a proper diagnosis. This way you will know the best way to treat your rash and prevent the spread of infection to others.

If you are interested in other Pediatric Advice Stories about topics discussed:

Chicken Pox Vaccine

Chicken Pox Immunity

Impetigo

Scabies

Norwegian Scabies

Contact Dermatitis

References:
(1)Pang M. Spot the Rash. Infectious Diseases in Children. 2006. March:90.
(2)Hall S, Maupin T, Seward J. Second varicella infections: Are they more common than previously thought: Pedaitrics.2002.
(3) American Academy of Pediatrics. Varicella-Zoster Infections. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:573-577.
(4)Krathen R, Hsu S. Vesicular lesions in an elderly woman with pneumonia. The Clinical Advisor. 2006. July:86,93.
(5)Treadwell P. Spot the Rash. Infectious Diseases in Children. 2006. September:104.
(6)Sharrar RG, LaRussa P, Galea SA. The post marketing safety profile of varicella . Vaccine. 2001.19:915-923.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infectious Diseases

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