Kids' Health Chickenpox Chickenpox Guide Chickenpox Guide Symptoms Causes Diagnosis Treatment Prevention Symptoms of Chickenpox By Vincent Iannelli, MD facebook Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. Learn about our editorial process Vincent Iannelli, MD Medically reviewed by Medically reviewed by Lyndsey Garbi, MD on July 17, 2019 linkedin Lyndsey Garbi, MD, is a pediatrician who is double board-certified in pediatrics and neonatology. Learn about our Medical Review Board Lyndsey Garbi, MD Updated on November 19, 2019 Print Table of Contents View All Table of Contents Frequent Symptoms Rare Symptoms Complications When to See a Doctor Next in Chickenpox Guide Will You Get Chickenpox? By the time rash, fever, swollen glands, and other symptoms of chickenpox (varicella) begin to appear, the virus will already have been in a person's body for a week or more. According to the Centers for Disease Control and Prevention (CDC), the typical incubation period for the varicella virus—the amount of time between when someone is exposed to it and when symptoms begin to show up—averages 14 days, with a range of 10 to 21 days. A person is considered contagious one to two days before a rash appears until that rash completely crusts over. © Verywell, 2018 Frequent Symptoms Otherwise healthy people who become sick after being exposed to varicella will develop a cluster of symptoms that are typical of any viral infection in addition to the telltale chickenpox rash. In some people, particularly adults, the non-rash symptoms will appear before the rash does. In kids, the rash is often the first sign of chickenpox. Non-Rash Symptoms Most of these symptoms last for a day or two and then disappear as the rash appears. They include: Fever (usually mild, around 102 degrees, although it can go as high as 105 degrees) Malaise Headache Loss of appetite Mild abdominal pain Swollen glands Remember that a person infected with the varicella virus can be contagious during the couple of days they have these pre-rash, non-specific symptoms. Chickenpox Rash This photo contains content that some people may find graphic or disturbing. See Photo Alex Tihonovs / EyeEm / Getty Images The chickenpox rash usually appears first on the torso, scalp, and face, and then spreads to the arms and legs. The rash also can cause lesions on mucous membranes in the eyes, mouth, and vagina (but this isn't common). Each chickenpox lesion starts as a 2- to 4-millimeter red papule with an irregular outline, upon which a thin-walled, clear vesicle filled with a highly-contagious fluid develops. The vesicle often is described as looking like a "dew drop." After eight to 12 hours, the fluid in the vesicle becomes cloudy and the vesicle breaks, leaving behind a crust. Once a lesion has crusted over it's no longer considered contagious. The crust usually falls off after about seven days. However, as old lesions crust over and fall away, new ones continue to form, and so it's typical to have lesions in different stages all at one time. Until all lesions have crusted over and no new ones have formed, a person is considered contagious. If you or your child come down with chickenpox, you'll need to stay home from school, work, and other activities to avoid spreading the virus, even if you're feeling fine otherwise. The chickenpox rash is extremely itchy, but it's important not to scratch. When lesions or crusts are scratched off or become infected from contact with dirt under fingernails, unsightly scars can form. For that reason, dealing with the itch is a key part of chickenpox treatment. The number of chickenpox lesions a person gets varies. The typical range is 100 to 300 lesions. Adults and older kids usually develop more lesions than young children. People who have previously traumatized skin, such as from a sunburn or eczema, may develop a more extensive rash than others. Rare Symptoms On rare occasions, children who have been partially vaccinated (had one dose of the varicella vaccine) or even fully vaccinated (have had both doses) come down with chickenpox anyway. Kids with so-called "breakthrough chickenpox" are less contagious than those who haven't been vaccinated. Their symptoms are milder, too—so mild in some cases that breakthrough chickenpox can be misdiagnosed as bug bites or other childhood rashes. The symptoms of breakthrough chickenpox include: Fewer than 50 or so lesions Few or no vesicles (which is why they aren't as contagious) Low or no fever Quick recovery (within three to five days) Complications For people who are in good health in general, chickenpox isn't likely to lead to any serious complications. However, around 14,000 people are hospitalized in the United States each year as a result of the disease. For about 100 of them, it will be fatal. As many as a third of people who get chickenpox as adults are at risk of serious complications, especially seniors and those with compromised immune systems. Bacterial Infection The most common complication of varicella is a secondary bacterial infection of the chickenpox lesions typically caused by Staphylococcus aureus or Streptococcus pyogenes, resulting in skin infections such as a impetigo, furunculosis, cellulitis, and erysipelas, as well as an infection of lymph nodes known as lymphadenitis. These infections are mostly superficial and easily treated with antibiotics. However, there is a risk that the bacteria can spread into the bloodstream, leading to a condition called bacteremia. People with bacteremia are at risk of bacterial pneumonia as well as other potentially serious infections, including meningitis, arthritis, osteomyelitis, and sepsis. Neurologic Complications The second most common set of complications of chickenpox involves the nervous system. One of the more serious neurological disorders associated with chickenpox is a childhood condition called acute cerebellar ataxia. Symptoms include fever, irritability that gets worse over time, difficulty walking, and speech impairment that can persist for days or even weeks. Fortunately, these symptoms usually resolve on their own. Another potential neurological complication of chickenpox is varicella meningoencephalitis, an infection that causes the membranes that surround and protect structures in the nervous system to become swollen and inflamed. Symptoms can include a headache, sensitivity to light, neck stiffness and pain, delirium, and seizures. The people most at risk for developing meningoencephalitis after being infected with the varicella virus are those who have a compromised immune system, such as patients in a late stage of infection with human immunodeficiency virus (HIV). Respiratory Complications Varicella pneumonia is the leading cause of varicella-related illness and death in adults. The disease develops when the virus travels to the lungs via the bloodstream, where it causes infection. Approximately one in every 400 adults who come down with chickenpox will be hospitalized as a result of this illness. The risk factors for varicella pneumonia include: Getting chickenpox at an older age Rash with a large number of lesions A compromised immune system Pregnancy (especially in the third trimester) Smoking Chronic obstructive pulmonary disease (COPD) Liver Complications A common complication of chickenpox is transient hepatitis, a temporary inflammation of the liver that usually doesn't cause symptoms and tends to get better without treatment. According to the Mayo Clinic, some children and teens recovering from a viral infection—particularly chickenpox or flu—are at risk of developing Reye's syndrome, a rare condition that causes swelling of the liver and brain. Reye's syndrome has also been linked to aspirin, so even though aspirin is approved for kids older than 2, it's best not to give this drug to them to treat symptoms of chickenpox (or other viral infections). Shingles After a person is infected with chickenpox, the virus is not completely eliminated from the body. Instead, it travels to points in the nervous system called ganglia, where branches of nerves come together, remaining inactive and latent. Certain triggers can force the dormant virus to suddenly become active again, often decades after the initial infection. When this happens, the virus will travel back down the nerve to the skin, causing painful, burning skin blisters along the nerve branch—a condition called shingles, or herpes zoster. Shingles most often affect adults over 50. When to See a Doctor Chickenpox is such an easily identifiable illness you often can get a diagnosis from a doctor over the phone. And like any viral infection, it usually gets better on its own. However, if while you have chickenpox you develop certain symptoms that indicate you might have a secondary infection or other complication, you should call a doctor for an appointment. These include: Blisters that become very red and tender; feel warm; become bigger, open sores; and drain pus A high fever that persists for more than a few days Swollen glands in the neck that are tender to the touch Rash that spreads to one or both eyes An inability to drink Dehydration Problems breathing or a constant cough, which could be signs of varicella pneumonia A severe headache, sensitivity to light, unusual sleepiness, confusion, or constant vomiting, which together could indicate brain inflammation These symptoms are cause for concern in kids and adults. If you have a small child with chickenpox who cries constantly and is inconsolable, that's reason to check in with the pediatrician as well. Chicken Pox Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Causes and Risk Factors of Chickenpox Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. Ayoade F, Kumar S. Varicella Zoster (Chickenpox) [Updated 2018 Nov 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Chickenpox: Overview. 2014 Jun 30 [Updated 2017 Apr 6]. Denny JT, Rocke ZM, McRae VA, et al. Varicella Pneumonia: Case Report and Review of a Potentially Lethal Complication of a Common Disease. J Investig Med High Impact Case Rep. 2018;6:2324709618770230. Published 2018 Apr 18. doi:10.1177/2324709618770230 Mckinnon HD, Howard T. Evaluating the febrile patient with a rash. Am Fam Physician. 2000;62(4):804-16. Leonid I, Evelyn L. Primary varicella in an immunocompetent adult. J Clin Aesthet Dermatol. 2009;2(8):36–38. Blair RJ. Varicella Zoster Virus. Pediatr Rev. 2019;40(7):375-377. Chickenpox. Paediatr Child Health. 1999;4(8):569–574. doi:10.1093/pch/4.8.569 Schmid DS, Jumaan AO. Impact of varicella vaccine on varicella-zoster virus dynamics. Clin Microbiol Rev. 2010;23(1):202–217. doi:10.1128/CMR.00031-09 Suryam V, Das AL. Chickenpox Appearing in Previously Vaccinated Individuals. Med J Armed Forces India. 2009;65(3):280–281. doi:10.1016/S0377-1237(09)80028-2 Leung J, Broder KR, Marin M. Severe varicella in persons vaccinated with varicella vaccine (breakthrough varicella): a systematic literature review. Expert Rev Vaccines. 2017;16(4):391-400. Ellis, Glenn The 411 about Chickenpox and Shingles. The Philadelphia Tribune. January 10, 2012. Bhatt DD, Kharkwal N, Yadav DK. Staphylococcal endocarditis after chicken pox in a child with structurally normal heart. Ann Pediatr Cardiol. 2017;10(3):312–313. doi:10.4103/apc.APC_17_17 Lee KG, Cheng MO. Varicella-zoster infection with secondary bacteremia and extensive facial abscesses. Med J Malaysia. 2012;67(5):529. Paul R, Singhania P, Hashmi M, Bandyopadhyay R, Banerjee AK. Post chicken pox neurological sequelae: Three distinct presentations. J Neurosci Rural Pract. 2010;1(2):92–96. doi:10.4103/0976-3147.71718 Corti M, Villafañe MF, Vittar N, et al. MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE. Rev Inst Med Trop Sao Paulo. 2015;57(6):505–508. doi:10.1590/S0036-46652015000600007 Spernovasilis N, Milioni A, Gialamas I, Kokorakis E, Fanti G. Varicella-zoster virus meningitis with hypoglycorrhachia in a young immunocompetent adult without rash: A case report and literature review. IDCases. 2018;12:104–106. Published 2018 Apr 13. doi:10.1016/j.idcr.2018.04.008 Denny JT, Rocke ZM, McRae VA, et al. Varicella Pneumonia: Case Report and Review of a Potentially Lethal Complication of a Common Disease. J Investig Med High Impact Case Rep. 2018;6:2324709618770230. Published 2018 Apr 18. doi:10.1177/2324709618770230 Singh A, Parkash S, Gupta SK, Soni RK. Severe Varicella Pneumonia in Adults: Seven Years' Single-center Experience from India. Indian J Crit Care Med. 2018;22(3):162–167. doi:10.4103/ijccm.IJCCM_495_17 Cianciara J, Laskus T. Development of transient autoimmune hepatitis during interferon treatment of chronic hepatitis B. Dig Dis Sci. 1995;40(8):1842-4. Bailey JM, Low CE, Pupillo MB. Reye's syndrome and aspirin use: a possible immunological relationship. Prostaglandins Leukot Med. 1982;8(3):211-8. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Shingles: Overview. 2014 Nov 19 [Updated 2019 Jan 21].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279624/ Facts about chickenpox. Paediatr Child Health. 2005;10(7):413–414. doi:10.1093/pch/10.7.413 Ziebold C, Von kries R, Lang R, Weigl J, Schmitt HJ. Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001;108(5):E79. Additional Reading Abro, AH, et.al. Hepatic Dysfunction is Frequent in Varicella Infection. Rawal Med Jour. July 2008. 33(2). American Academy of Dermatology. Shingles: Overview. Oct 27, 2017. Centers for Disease Control and Prevention (CDC). Chickenpox (Varicella) | Clinical Overview. July 1, 2016. Mayo Clinic. Reye's Syndrome. Aug 12, 2014. Michigan Medicine, University of Michigan. Chickenpox (Varicella): When To Call a Doctor. May 4 2017.