What Chickenpox Looks Like

Pictures of the Rash in All of Its Stages

Chickenpox is a highly contagious infection caused by the varicella-zoster virus (VZV). It's characterized by the outbreak of a blister-like rash that appears first on the face and trunk, and then quickly spreads over the body. While many can easily identify (or suspect) a case, perhaps because of known exposure or knowledge of what chickenpox looks like, reviewing pictures of chickenpox in its various stages can offer a sense of how the rash will progress—and help you know when you're least likely to pass the virus on to someone else.

From the time symptoms first appear, it usually takes a week or two for the immune system to bring the infection under control.

VZV Transmission

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While there is a vaccine able to prevent chickenpox, there is no cure and the varicella-zoster virus is easily spread from person to person. While chickenpox is largely considered a childhood disease, anyone who has not been previously infected or vaccinated is at risk.

The virus is mainly spread by touching or breathing in the viral particles from open chickenpox blisters. It can also be passed through tiny droplets of saliva as an infected person talks or breathes. This is why chickenpox can sweep quickly through grade schools where children are in close contact and in confined spaces.

Once exposed to the chickenpox virus, symptoms will develop within 10 to 21 days.

While chickenpox is not life-threatening, serious complications can sometimes occur. Adults newly infected with chickenpox are more likely to experience severe illness and ​​complications, including pneumonia or encephalitis (inflammation of the brain). If needed, antiviral drugs may be prescribed to reduce the severity and duration of the illness.

Once a VZV infection occurs, the virus will remain in your body for the rest of your life. In later years, the virus may suddenly reactivate, causing shingles (herpes zoster virus). 

Prodromal Phase

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The first sign of chickenpox in children and adults is headache, nausea, muscles aches, and malaise (a general feeling of unwellness). A runny nose and cough are also common.

The prodromal phase of infection may begin four to six days after exposure as the virus moves from the initial site of infection (the respiratory tract an/or eyes) to the lymph nodes. From there, the virus will spread into the bloodstream and trigger the initial flu-like symptoms. This is referred to as primary viremia.

Even before the outward signs of the disease appear, nasal secretions, saliva, and even teardrops will be extremely infectious to anyone comes into contact with them.

Secondary Viremia (Blister Stage)

Rear View Of Shirtless Girl With Chickenpox
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Secondary viremia, as known as the blister stage, begins as early as 10 days after exposure. This is the stage during which the virus will invade the uppermost layer of skin, known as the epidermis, as well as the tiny blood vessels that traverse the epidermal layer.

The infection will trigger the rapid accumulation of fluid just beneath the skin's surface and the formation of tiny, fluid-filled blisters known as vesicles. People often describe the rash as a "dew drop on a rose petal" due to its bright, symmetrical, and almost transparent appearance.

Fever is characteristic of secondary viremia, usually low-grade and easily treated with Tylenol (acetaminophen).

Warning for Children

Aspirin should never be given to children with a viral infection, as it may trigger a potentially life-threatening reaction known as Reye's syndrome.

Mouth Sores (Enathem)

Even prior to the development of skin vesicles, there may be an outbreak of blisters on the mucous membranes of the mouth (referred to as enathem). While they are triggered in the same way as those on the skin, the oral lesions will often look like tiny grains of white sand surrounded by a red ring.

Chickenpox enathem can be extremely painful when they erupt, making eating difficult. They can be treated with a topical oral analgesic as well as a bland, soft diet with cooling foods (such as ice pops, milkshakes, and smoothies). Spicy or acidic foods like tomatoes or citrus should be avoided.

Early-Stage Rash

Herpesviridae Chickenpox
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The speed by which chickenpox blisters develop can be truly astonishing. The rash will start as tiny red dots on the face, scalp, torso, and upper arms and legs. Thereafter, the blisters will rapidly spread, covering most of the body within 10 to 12 hours.

Many of the vesicles will begin to quickly consolidate and form into larger, cloudy blisters. The itching by this stage will often be intense. In some cases, an oral antihistamine may be prescribed to relieve itching and aid with sleep.

Rash Distribution

Little girl with chickenpox
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Chickenpox can spread to parts of the body that are not usually affected by infections, including the palms, soles, scalp, eyelids, anus, and genitals. 

Treatment options are limited and are not considered necessary in most cases. Some doctors may prescribe an oral antiviral drug called Zovirax (acyclovir) to people with compromised immune systems (to reduce the risk of complications) and pregnant mothers (to avoid fetal harm).

Zovirax is most effective if started within 24 hours of the first appearance of rash.

Formation of Pustules

As the infection progresses, the immune battle can lead to the formation of pus in the blisters. Pus essentially consists of dead white blood cells and bacteria combined with tissue debris and body fluids. 

While many of the blisters will erupt on their own, due to friction and abrasion with clothing, every effort should be made to avoid scratching. This not only reduces scarring, but it prevents the spread of infection even after an erupted lesion has crusted over.

Strategies to reduce itching include:

  • Oatmeals baths
  • Calamine lotion
  • Benadryl (diphenhydramine), which functions as both an antihistamine and sedative
  • Trimming the fingernails 
  • Cooling the skin with a cold, moist cloth
  • Wearing mittens or soft socks on the hands
  • Wearing loose-fitting cotton clothes
  • Keeping the bedroom cool at night

Only use mild soap when bathing and blot, rather there rub, the skin dry with a towel.

Umbilication and Scarring

After four to five days, as the erupted vesicles start to crust over, those that haven't done so will harden and form little indentations, called umbilication.

This is the stage during which the contagiousness of the disease will gradually wane and healing will begin.

It is also the time to remain vigilant as the open, ulcerated sores are vulnerable to infection. This most commonly involves staphylococcal or streptococcal bacteria. Secondary infections like these can lead to:

While uncommon, a secondary infection can sometimes spread into the bloodstream, causing a potentially life-threatening condition known as sepsis.

A secondary skin infection may be treated with a topical, oral, or injected antibiotic, depending on its severity. Cellulitis may require hospitalization and the administration of intravenous antibiotics and fluids.

You can reduce the risk of a secondary infection by washing your hands regularly with soap, trimming your nails, and avoid touching any open or crusted lesions.

Recovery

Baby with chickenpox
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Most chickenpox infection will fully resolve within two weeks. Some may take up to three, oftentimes as a result of a secondary infection which prolonged the recovery time.

When to Call Your Doctor

While most chickenpox infections are uncomplicated and readily managed at home, call your doctor if your child experiences any of the following:

  • A red, warm, or tender rash suggestive of a secondary infection
  • The development of rash in one or both eyes
  • High fever (over 102 degrees), disorientation, stiff neck, shortness of breath, tremors, vomiting, and rapid heartbeat, which are suggestive of encephalitis and sepsis

A Word From Verywell

Chickenpox can be easily prevented with the Varivax vaccine. The two-shot series is recommended as part of a child's routine vaccination series and can provide complete protection in 98 percent of cases. If your child hasn't been vaccinated, speak with your health care provider to start the series as soon as possible. You can also get vaccinated if you haven't done so and are at an increased risk of exposure.

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