Chickenpox (varicella, chiken-pox) is an acute eruptive infectious disease caused by the chickenpox virus (VZV). It is highly infectious and can spread through contact or droplets. The incidence rate in susceptible children can reach 95%, with preschool-aged children being the most commonly affected, often occurring successively in collective childcare settings. The disease is characterized by the simultaneous presence of polymorphic rashes (papules, vesicles, and crusts) of varying sizes and stages. Most cases resolve on their own, but in individuals with immunodeficiency, severe eczema, or those undergoing long-term hormone or cytotoxic drug treatment, symptoms can be severe and even life-threatening.

bubble_chart Clinical Manifestations

1. Fever occurs simultaneously with the rash, or eruption appears without fever.
2. Distribution and characteristics of the rash
   1. The rash is more concentrated on the scalp and trunk, with fewer lesions on the limbs, showing a centripetal distribution. In the early stages when the rash is sparse, detecting chickenpox on the scalp and hairline can confirm the diagnosis. Herpes may also occasionally appear on the oral mucosa, pharynx, conjunctiva, and genital area.
   2. The skin lesions initially present as small red macules and papules, which quickly develop into vesicles. These are oval-shaped, thin-walled, soft to the touch, and prone to rupture, often accompanied by cutaneous pruritus. They rapidly ulcerate and form scabs. On the same body part (especially the trunk), macules, papules, vesicles, ulcers, and scabs—representing different stages of the rash—may appear in batches over 3–5 days.
   3. Scabs fall off in 1–3 weeks without scarring, though secondary infections may leave small permanent scars.

bubble_chart Auxiliary Examination

1. No significant changes in white blood cells.
2. Virus isolation: the virus can be isolated from the herpes fluid.
3. Stage of convalescence: A serum antibody titer increase of % or more has retrospective diagnostic significance.
4. Use PCR to detect VZV-DNA in chickenpox cytoplasm, scabs, and throat secretions.

bubble_chart Diagnosis

The epidemiological history indicates exposure to chickenpox approximately 2 to 3 weeks ago.

bubble_chart Treatment Measures

1. Strengthen nursing care and avoid scratching the blisters to prevent secondary infection. When blisters rupture, apply 1-2% Chinese Gentian Violet or 5% sulfonamide ointment. For itchy rashes, administer 0.2% diphenhydramine syrup at 0.5–1 ml/(kg·d), divided into two oral doses, or chlorpheniramine 2–4 mg twice daily, along with oral vitamin C. Topically apply calamine lotion.
2. Some foreign studies have used cimetidine at 10–20 mg/(kg·d), divided into four oral doses, to treat chickenpox, achieving effects such as relieving itching and shortening the course of the disease.
3. Use 0.1% idoxuridine eye drops to treat herpetic conjunctivitis.
4. A single intramuscular injection of vitamin B12 at 500 μg can alleviate rashes and accelerate blister crusting.
5. For severe cases, acyclovir can be used at a dose of 250 mg/m² per day, divided into three doses administered as slow intravenous infusions every 8 hours. Alternatively, gamma globulin injections may be considered.
6. For children previously on steroid therapy, reduce the steroid dose to maintenance levels and resume the original dose only after complete recovery from chickenpox.

bubble_chart Prevention

AD

TCM's treatment of atopic dermatitis is more comprehensive, fundamental, non-toxic and effective than Western medicine's symptomatic treatment

1. Isolate the affected child until all the rashes have crusted over.
2. Susceptible children exposed to chickenpox should be quarantined for 21 days.
3. For weak children or those with eczema, immunodeficiency, or undergoing treatment with hormones or cytotoxic drugs, passive immunization can be administered after exposure to chickenpox using human gamma globulin (placental globulin, convalescent serum from herpes zoster or chickenpox, or zoster immune globulin). Administer gamma globulin at 0.4–0.6 ml/kg within 4 days of exposure, or 2–5 ml of convalescent serum, preferably within 24 hours, to prevent the disease or alleviate symptoms.
4. Active immunization: China has developed a "live attenuated chickenpox vaccine," approved by the Ministry of Health and now in use, which can prevent chickenpox. The aforementioned children should receive this vaccination.

bubble_chart Differentiation

Currently, smallpox has been eradicated. This disease should be differentiated from papular urticaria, which is more common on the limbs, with hard blisters that are not easily broken and have a uniform appearance.