What the Stages of Chickenpox Look Like

Chickenpox is a highly contagious infection caused by the varicella-zoster virus (VZV). It causes a blistering rash first on the face and trunk, and then the rest of the body.

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

This article shows chickenpox in its various stages to give you a sense of how the rash will progress. This guide can help you to know when you're least likely to pass on the virus.

VZV Transmission

boy sneezing in classroom

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There is a vaccine to prevent chickenpox. Once you have the infection, though, there is no cure. It has to run its course.

The virus spreads easily from person to person. Chickenpox is largely a childhood disease, but anyone who hasn't had it before or hasn't been vaccinated is at risk.

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

Once you're exposed to the virus, symptoms will develop within 10 to 21 days.

Chickenpox is not life-threatening, but serious complications sometimes occur.

Adults newly infected with chickenpox are more likely to have a severe case. They're also more likely to have ​complications like pneumonia or encephalitis (inflammation of the brain).

A healthcare provider can prescribe antiviral drugs to keep the illness from becoming severe. These drugs can also shorten the illness.

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

Prodromal Phase

Girl with a headache

JGI / Tom Grill / Getty Images

The first stage of chickenpox is called the prodromal phase. It often causes these symptoms:

  • Headache
  • Nausea
  • Muscle aches
  • Malaise, or a feeling of being unwell
  • Runny nose
  • Cough

The prodromal phase begins four to six days after exposure. In this stage, the virus moves from the respiratory tract or eyes to the lymph nodes.

From there, the virus spreads to the bloodstream. That's when it triggers the first flu-like symptoms. This is referred to as primary viremia.

Even before the outward signs of the disease show up, nasal secretions, saliva, and even teardrops are extremely infectious to anyone who comes into contact with them.

Secondary Viremia (Blister Stage)

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Rear View Of Shirtless Girl With Chickenpox
Alex Tihonovs / EyeEm / Getty Images

Secondary viremia is also called the blister stage. It starts as early as 10 days after exposure. This is the stage where the virus shows up on the outer layer of skin, known as the epidermis. It spreads through tiny blood vessels that span the skin.

The infection causes fluid-filled blisters known as vesicles. People often describe the rash as a "dew drop on a rose petal." That's because the blisters look bright, symmetrical, and almost see-through.

During this phase, people often have a low-grade fever. It can usually be treated with Tylenol (acetaminophen).

Warning for Children

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

Mouth Sores (Enanthem)

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Blisters in a child's mouth

CDC

Even before blisters appear on the skin, they can break out in the mouth. This condition is called enanthem. The sores often look like tiny grains of white sand inside a red ring.

Chickenpox enanthem can be very painful. They make it hard to eat. You can try a topical oral analgesic (pain reliever). You can also opt for soft, bland, or cooling foods such as ice pops, milkshakes, or smoothies. Avoid spicy or acidic foods like tomatoes or citrus.

Early-Stage Rash

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Herpesviridae Chickenpox

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Chickenpox blisters spread quickly. The rash starts as tiny red dots on the face, scalp, torso, and upper arms and legs. Within 10 to 12 hours, blisters cover the whole body.

Many of the vesicles join together into larger, cloudy blisters. The itching can be intense. In some cases, an oral antihistamine may be prescribed to relieve itching and aid with sleep.

Rash Distribution

Little girl with chickenpox on her hand
MilosBataveljic / Getty Images

Chickenpox can spread to parts of the body that are not usually affected by infections. The palms, soles, scalp, eyelids, anus, and genitals can all be involved. 

Treatment options are limited. In most cases, treatment isn't necessary.

Some healthcare providers may prescribe an oral antiviral drug called Zovirax (acyclovir) to people with weakened immune systems. This medication may lower the risk of complications. It's sometimes prescribed for pregnant mothers to avoid fetal harm.

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

Formation of Pustules

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chicken pox pustule

 CDC / Heinz F. Eichenwald

As the infection grows, the immune battle can lead to pus in the blisters. Pus is made up of dead white blood cells along with bits of tissue and body fluids. Many of the blisters open on their own as they rub against clothing.

It's best to avoid scratching, which can cause scars. It can also make it more likely that the virus will spread. Lesions can spread infection even after they've crusted over.

To reduce itching, try:

  • Oatmeal baths
  • Calamine lotion
  • Benadryl (diphenhydramine), which helps with itching and sleep
  • 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

When you bathe, use a mild soap. Blot, rather than rub, the skin dry with a towel.

Umbilication and Scarring

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Pox on a boy's back

 CDC

After four to five days, the vesicles start to crust over. They may harden and form little indentations called umbilication.

During this stage, the disease gradually becomes less contagious. Healing begins.

Watch closely during this phase. The sores can easily become infected. Staphylococcal or streptococcal bacteria can lead to:

These secondary infections are not common. When they develop, they can sometimes spread into the bloodstream. The result can be a life-threatening condition known as sepsis.

A secondary skin infection may be treated with a topical, oral, or injected antibiotic, depending on how severe it is. Cellulitis may need intravenous (IV) antibiotics and fluids given in the hospital.

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

Recovery

Baby with chickenpox
TEK IMAGE / Getty Images

Most chickenpox infections resolve within two weeks. Some may take up to three, especially if a secondary infection stretches out the recovery time.

When to Call Your Healthcare Provider

Most chickenpox infections are not complicated and can be managed at home. Call your healthcare provider if your child has any of the following:

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

Summary

Chickenpox is an infection caused by the varicella-zoster virus. It spreads very easily from person to person. Once you're infected, the virus stays in your body your whole life. It can cause shingles (herpes zoster) later in life.

The good news is that there's a vaccine to prevent most cases of chickenpox. The vaccine is available for adults and children.

When you've been infected with varicella, flu-like symptoms usually show up within four to six days. Around 10 days after infection, small round blisters spread over the skin. They are itchy and full of fluid. Some people also have painful mouth sores.

Four or five days later, the blisters crust over. Chickenpox is still contagious at this point. Other skin infections can take hold, especially if you've scratched the blisters or your immune system isn't working well. These infections can be serious.

Most of the time, chickenpox heals on its own in a week or two. Until then, you can treat the itch and pain with baths or over-the-counter medications. If you think another infection is developing, contact a healthcare provider right away.

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. It provides complete protection in 98% of cases.

If your child hasn't been vaccinated, speak with your healthcare provider to start the series as soon as possible. You can also get vaccinated if you have a higher risk of exposure.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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