**Did you know that if one person in your household contracts chickenpox, there is a 90% chance that unvaccinated family members will also catch it?**¹⁶ ¹⁷
Chickenpox (Varicella/ ठेउला / Theula) is a highly contagious viral infection that remains common across Kathmandu and Nepal. While often dismissed as a “mild” childhood rite of passage, it can be dangerous for adults and leads to permanent scarring if mismanaged. This guide covers medically backed strategies for treatment, vaccination, and scar prevention specifically for Nepali families.
What Causes Chickenpox?
Chickenpox is caused by the varicella-zoster virus (VZV), which belongs to the herpes family.¹ It spreads through the air when an infected person coughs or sneezes, or through direct contact with fluid from blisters.¹ ²
The Incubation Period
The incubation period (the time between exposure and symptoms) is typically 14 to 16 days, though it can range from 10 to 21 days.¹⁰ ¹¹ During this silent phase, the virus multiplies in your lymph nodes before entering the bloodstream and eventually causing the skin reaction.¹
Symptoms: Is It Chickenpox?
Before the rash appears, patients often experience a prodrome phase with early warning signs.
Early Warning Signs (1 to 2 Days Before Rash)
- Fever, usually mild (100 to 102°F)³
- Fatigue and feeling unusually tired or wiped out³
- Headache and loss of appetite³
The 3 Stages of the Rash
The hallmark of chickenpox is pleomorphism, meaning you will see all three stages of the rash on the body at the same time:⁴ ⁵
- Papules: Raised pink or red bumps
- Vesicles: Fluid-filled blisters (often described as “dew drops on a rose petal”)¹
- Crusts: Scabs that cover broken blisters
Medical Treatment Protocols
Treatment strategies differ significantly by age and weight. Always consult a board-certified dermatologist before administering medication.
Antiviral Treatment (Acyclovir)
For Adults: Varicella symptoms in adults are often severe. To be effective, acyclovir must be started within 24 hours of the rash appearing.⁶ The standard protocol involves taking 800mg five times daily for 5 to 7 days to maintain antiviral levels in the blood.⁷
For Children: Healthy children often recover with supportive care. However, for those at risk or with severe symptoms, weight-based dosing (typically 20 mg/kg) is prescribed.⁷
Treatment Timeline and Dosage Reference
| Patient Group | Medication | Typical Dosage | Critical Window |
|---|---|---|---|
| Adults | Acyclovir | 800mg (5x daily)⁷ | Start within 24 hours of rash⁶ |
| Children (<40kg) | Acyclovir | 20 mg/kg (4x daily)⁷ | Start within 24 hours of rash |
| Fever Management | Paracetamol | As needed | NEVER use Aspirin |
| Itch Control | Antihistamines | As prescribed | Throughout infection |
⚠️ Warning: Never give aspirin to children or teenagers with chickenpox, as it can lead to Reye’s Syndrome, a life-threatening condition affecting the liver and brain. Do not start Antiviral treatment without Consultation with Doctor.
Chickenpox vs Shingles: What Is the Difference?
Many patients in Nepal confuse these two conditions. Both are caused by the same virus, but they behave differently.
| Feature | Chickenpox (Varicella) | Shingles (Herpes Zoster) |
|---|---|---|
| Primary Cause | Initial infection with VZV¹ | Reactivation of dormant VZV¹⁸ |
| Who Gets It? | Mostly children (unvaccinated) | Mostly adults over 50²⁰ |
| Rash Pattern | Widespread (whole body)⁴ | Localized (single band or stripe)¹⁹ |
| Contagiousness | Highly contagious (Airborne)¹⁵ | Less contagious (Contact only) |
| Pain Level | Itchy | Painful or burning sensation |
Prevention: The Varicella Vaccine in Nepal
The most effective way to prevent infection is vaccination. The vaccine uses a live, weakened virus to build immunity.¹²
Vaccination Schedule
- Dose 1: 12 to 15 months of age¹²
- Dose 2: 4 to 6 years of age¹²
- Adults: Two doses, administered 4 to 8 weeks apart¹²
What Is Breakthrough Varicella?
About 10% of vaccinated people may still get chickenpox. This is called breakthrough varicella. However, these cases are significantly milder, typically resulting in:
- Fewer than 50 lesions (versus 250-500 in unvaccinated)
- Lower fever
- Faster recovery¹²
Scar Management: Preventing Pockmarks
Scars occur when inflammation damages the collagen in the dermis layer of the skin.¹³ This is usually caused by secondary bacterial infections from scratching.
Best Practices for Scar Prevention
- Trim Nails: Keep fingernails short to prevent breaking the skin
- Calamine Lotion: Apply soothing lotion to reduce the urge to scratch
- Daily Hygiene: Bathing reduces bacterial load on the skin¹³
- Cotton Gloves: Use at night for young children
- No Picking: Never pick at scabs or pop blisters
When to Start Scar Treatment
Begin scar treatment as soon as blisters close completely.¹⁴ Apply medical-grade scar cream 2 to 3 times daily. If scars do form, treatments like microneedling or laser resurfacing can help improve skin texture once the infection has fully cleared.¹⁴
How Long Is Chickenpox Contagious?
You become contagious 1 to 2 days before the rash appears and remain contagious until all blisters form dry crusts, typically 5 to 7 days after rash onset.¹⁰
Keep your child home from school during this entire period. Some schools require a doctor’s note confirming non-contagious status before return.
How Chickenpox Spreads
Chickenpox transmits through:
- Airborne droplets when an infected person coughs or sneezes¹⁵
- Direct contact with blister fluid¹⁶
- Contaminated surfaces (towels, toys, clothing)
Secondary attack rate: If one unvaccinated household member gets chickenpox, over 90% of susceptible family members will develop infection.¹⁶ ¹⁷
When the Virus Stays Dormant: Understanding Shingles Risk
After chickenpox resolves, VZV doesn’t leave your body. Instead, it travels along nerve pathways and remains dormant in nerve cells near your spinal cord for years or decades.¹⁸
Why Does VZV Reactivate as Shingles?
This dormant virus can reactivate later in life as shingles (herpes zoster), especially after age 50 when immunity naturally declines.²⁰
Factors that trigger reactivation:
- Aging and natural immune decline
- Chronic stress and elevated cortisol²² ²³
- Immunosuppressive medications
- Cancer or HIV/AIDS²⁰
- Organ transplantation
Lifetime risk: Approximately 30% of people who had chickenpox will develop shingles at some point in their lives.
When to Seek Medical Attention
Contact a dermatologist immediately if you experience:
- ✓ Any adult with suspected chickenpox (antiviral treatment is time-sensitive)
- ✓ Rash spreading to eyes or genitals
- ✓ Fever exceeding 102°F (39°C) or lasting more than 4 days
- ✓ Signs of bacterial infection (very red, hot, tender areas with pus)
- ✓ Breathing difficulty or persistent cough
- ✓ Severe headache, confusion, or difficulty walking
- ✓ Pregnancy with chickenpox exposure
Remember: Starting treatment within 24 hours provides the best outcomes.⁶
Frequently Asked Questions About Chickenpox
Can you get chickenpox twice in your lifetime?
Second chickenpox infections are extremely rare but can occur in immunocompromised individuals. Most people develop lifelong immunity after one infection. The virus can reactivate later as shingles, which is different from getting chickenpox again.+2
Is it safe to be around someone with shingles if I’ve never had chickenpox?
If you’ve never had chickenpox or the vaccine, you can catch chickenpox (not shingles) from direct contact with shingles blisters. Shingles is less contagious than chickenpox because it doesn’t spread airborne, only through blister fluid contact.
Can I go swimming during chickenpox recovery?
Avoid public pools until all blisters completely crust over. Pool water spreads infection to others, and chlorine irritates healing skin. Home baths are acceptable, but avoid hot water that increases itching.
Will chickenpox scars fade completely on their own?
Shallow scars may fade significantly over months to years with early treatment. Deep scars from scratching or infection typically remain permanent without professional treatment. Visit Derma Clinic Kathmandu for scar reduction procedures if needed.
Can pregnant women take the chickenpox vaccine?
No. Pregnant women cannot receive the varicella vaccine because it contains live virus. Women planning pregnancy should vaccinate at least one month before conceiving. If pregnant and exposed to chickenpox, contact Derma Clinic Kathmandu immediately for immune globulin treatment.
How long should my child stay home from school with chickenpox?
Keep your child home until all blisters form dry crusts with no fluid, typically 5 to 7 days after rash onset. Some schools require a doctor’s note confirming non-contagious status before return.
Can antibiotics cure chickenpox?
No. Antibiotics don’t work against viruses. Antiviral medications (acyclovir) target chickenpox, while antibiotics treat only secondary bacterial infections in scratched blisters. Proper diagnosis at Derma Clinic Kathmandu ensures correct treatment.
Is chickenpox more dangerous during certain seasons?
The virus doesn’t become more dangerous seasonally, but outbreaks peak during cooler months when people gather indoors in close contact. In Nepal’s varied climate, cases occur year-round with regional pattern variations.
Can I use neem leaves or turmeric paste on chickenpox blisters?
While traditional remedies have antimicrobial properties, applying anything directly to open blisters risks bacterial infection. Stick to medically approved treatments recommended by Derma Clinic Kathmandu. You can discuss safe traditional approaches with our doctors.
If I had chickenpox as a child, can my baby catch it from me now?
No. You can’t spread chickenpox from old infections. The dormant virus in your nerves doesn’t transmit. However, if you develop shingles later, someone who never had chickenpox can catch chickenpox (not shingles) through direct shingles rash contact.
Expert Chickenpox Care in Kathmandu
Recovering from chickenpox is about more than just waiting for the spots to fade. It’s about ensuring your skin returns to its healthy, scar-free state. At Derma Clinic Kathmandu, your care is led by Dr. Utsav Sharma (NMC No. 7619), a board-certified Dermatologist and Venereologist with over 14 years of experience in treating complex viral infections and skin diseases.
Whether you need urgent antiviral management to shorten the illness or advanced scar revision therapies such as microneedling and TCA, Dr. Sharma’s evidence-based approach ensures safe, compassionate, and effective results for your entire family.
Don’t let chickenpox leave a lasting mark. Book your consultation at our clinic today for expert care you can trust. You can Book Appointment Online Directly You can WhatsApp us or Call us at 9801358600
Derma Clinic Location:
References
- Varicella-Zoster Virus (Chickenpox) – StatPearls – NCBI Bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK448191/
- What is Chickenpox Pathophysiology and How Does Varicella Zoster Virus Spread? Liv Hospital. https://int.livhospital.com/what-is-chickenpox-pathophysiology-and-how-does-varicella-zoster-virus-spread/
- How long does it take to recover from chickenpox? Vinmec International Hospital. https://www.vinmec.com/eng/blog/how-long-does-it-take-to-get-rid-of-chickenpox-en
- Clinical Features of Chickenpox (Varicella). Centers for Disease Control and Prevention. https://www.cdc.gov/chickenpox/hcp/clinical-signs/index.html
- Chickenpox – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chickenpox/symptoms-causes/syc-20351282
- Treatment of Adult Chickenpox With Oral Acyclovir. JAMA Network. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/613970
- Acyclovir (oral route, intravenous route) – Side effects & usage. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/acyclovir-oral-route-intravenous-route/description/drg-20068393
- Laboratory Testing for Varicella-Zoster Virus (VZV). Centers for Disease Control and Prevention. https://www.cdc.gov/chickenpox/php/laboratories/index.html
- Interpreting Laboratory Tests. Centers for Disease Control and Prevention. https://www.cdc.gov/chickenpox/lab-testing/lab-tests.html
- Clinical Overview of Chickenpox (Varicella). Centers for Disease Control and Prevention. https://www.cdc.gov/chickenpox/hcp/clinical-overview/index.html
- Varicella (chickenpox). Colorado Department of Public Health and Environment. https://cdphe.colorado.gov/dcphr/communicable-disease-manual/varicella
- Chickenpox. World Health Organization. https://www.who.int/news-room/questions-and-answers/item/chickenpox
- Chickenpox Scars: Causes, Treatment Options, and Prevention. The London Scar Clinic. https://www.thelondonscarclinic.com/chickenpox-scars-treatment-options/
- Chickenpox scars: how to prevent or reduce. ALHYDRAN. https://www.alhydran.co.uk/blog/chicken-pox-scars/
- Chickenpox. National Centre for Infectious Diseases, Singapore. https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Chickenpox.aspx
- How is chickenpox transmitted? Vinmec International Hospital. https://www.vinmec.com/eng/blog/how-is-chickenpox-transmitted-en
- Chickenpox. Wikipedia. https://en.wikipedia.org/wiki/Chickenpox
- Pathophysiology and Diagnosis of Varicella Zoster Virus. Longdom Publishing. https://www.longdom.org/open-access/pathophysiology-and-diagnosis-of-varicella-zoster-virus-vzv-97245.html
- Shingles (herpes zoster). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/shingles-(herpes-zoster)
- What Causes Shingles to Activate and What to Do About It. Healthline. https://www.healthline.com/health/what-causes-shingles-to-activate
- Vzv Retinal Necrosis. National Center for Biotechnology Information. https://pmc.ncbi.nlm.nih.gov/articles/PMC2782836/
- How Does Stress Affect The Immune System Related To Shingles? Sri Ramakrishna Hospital. https://www.sriramakrishnahospital.com/blog/pain-management/how-can-stress-influence-the-development-of-shingles-through-the-immune-system/
- Shingles and Stress: Symptoms and Connection. Healthline. https://www.healthline.com/health/shingles-and-stress
- Epidemiological Outbreak Investigation of Chickenpox in Nawalparasi District, Nepal. Semantic Scholar. https://pdfs.semanticscholar.org/6d89/c9fa5b8a9aed8993cc2c2eddd1ced8ca0d30.pdf