Chickenpox: What the Rash Looks Like in Children and Adults

In 1772, the German scientist R. Vogel first used the term "varicella," but the causative agent of the disease was only found in 1911. Since then, much has been learned about this infection, but for a family it all begins with a simple question: does the rash look like chickenpox.

What chickenpox is

Varicella is an acute viral disease caused by the varicella-zoster virus, also known as human herpesvirus type 3. The same pathogen causes shingles in those who have had the disease: the virus remains in nerve ganglia for life and reactivates when immunity weakens. Transmission occurs by airborne droplets and through direct contact; contagiousness is described as one hundred percent — everyone who has not previously encountered the virus becomes ill. People of all ages are affected, but about half of cases occur in children aged 5–9 years, and approximately 10% of those affected are people aged 14 and older. The incubation period lasts from 10 to 21 days, more often 14–16 days; the patient is contagious from the end of this period, 48 hours before the rash appears, until all lesions have crusted over.

What the first eruptions look like

The main sign is an itchy spotted rash that can appear anywhere on the body. The color of the lesions depends on skin tone: they may be red, pink, darker, or almost the same as the surrounding skin, and on brown and black skin they are harder to notice. The rash either spreads widely or remains on a small area; in a typical case, it first appears on the face, chest, and back, and then moves to the rest of the body. Before the rash or along with it, there may be high fever, body aches, general malaise, loss of appetite, headache, and fatigue. In children, prodromal symptoms are often absent; in adults, fever and malaise usually occur 1–2 days before the eruptions.

Stages of the rash in varicella

The rash goes through three stages, but new lesions may appear at the moment when previous ones have already become vesicles or have crusted over, so different stages are visible on the skin at the same time. What is colloquially called pimples is the same evolution of a lesion.

• Spots — small lesions, usually less than a centimeter; some become raised and begin to form a round or slightly oval vesicle.
• Vesicles — fill with fluid, become shiny, itch intensely, and may rupture.
• Crusts — vesicles may rupture, and dark crusts form in place of some of them.

Where the eruptions appear: face, mucous membranes, oral cavity

The rash has no preferred areas: lesions can appear on any part of the body, including the mouth and the genital area, where they are especially painful; more often the rash starts on the face, chest, and back.

Chickenpox in adults and children: differences and complications

In children, chickenpox usually runs a mild course and resolves within 5–10 days; usually everything subsides on its own within 1–2 weeks. In people over 18 years of age, the course is more severe, and they die from chickenpox 25–175 times more often than children. Infants, adolescents, pregnant women, and people with weakened immunity also have a more severe course.

Complications include bacterial infection of the skin (in common parlance this form is often called purulent chickenpox), pneumonia, inflammation of the middle ear, eye lesions up to blindness, hepatitis, nephropathy, and neurological disorders. Neurological complications account for 1–7.5% of cases, of which 70.5% are encephalitis and 10.6% are meningitis; mortality in varicella encephalitis reaches 1–20%. A separate danger is neonatal chickenpox: if the mother becomes ill 5 days before delivery or in the first two days after, about 30% of newborns die.

When to see a doctor

The doctor assesses the rash and general condition. In unclear cases, they may order laboratory tests for varicella and shingles, including serological antibody tests. An examination is needed if the rash is atypical, and also when an adult, a pregnant woman, an infant, or a person with immunodeficiency is ill: these groups have a more severe course of the infection. Vaccination helps prevent the disease or soften its course.

Chickenpox itself is not a reason to call an ambulance; 103 or 112 — for a life-threatening condition.

This material is for reference: it helps recognize the rash, but does not replace consultation with a doctor who sees the patient.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer