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Chickenpox
Mostly reassurance — but avoid NSAIDs and spot the complications.
| If you find… | …then |
|---|---|
| Spots becoming red, hot, swollen and painful; child very unwell | Secondary bacterial infection / invasive group A strep — urgent |
| Breathing difficulty, chest pain | Varicella pneumonia (adults/smokers) — ED |
| Drowsiness, unsteadiness, seizures | Encephalitis / cerebellitis — ED |
| Neonate, pregnant, or immunocompromised | Urgent specialist advice (antivirals / immunoglobulin) |
| Bleeding into spots | Haemorrhagic varicella — ED |
- Onset of spots, fever
- Contacts: pregnant women, newborns, immunosuppressed
- Age; immunosuppression; pregnancy
- Eating/drinking; breathing
- Crops of spots → vesicles → crusts
- Signs of secondary infection
- Obs; chest if adult
Why no ibuprofen?
NSAIDs in chickenpox have been associated with severe skin and soft-tissue infections, including necrotising fasciitis. NHS and NICE advice is to avoid them.
Contacts matter
Always ask who else they’ll be near. A pregnant contact who isn’t immune, or a newborn, needs urgent advice.
Complication check
- Red, hot, painful spreading skin
- Breathing difficulty or chest pain
- Drowsy, unsteady, seizures
- Neonate, pregnant or immunocompromised
- Haemorrhagic spots
Any present: Complication or high risk → same-day specialist / ED. None present: Uncomplicated → home with advice.
| Investigation | Only if… |
|---|---|
| None | Clinical diagnosis |
Management & advice
- Paracetamol for fever/discomfort — avoid ibuprofen/NSAIDs (linked to severe skin infections)
- Fluids; loose cotton clothes; cut nails
- Calamine/emollient; antihistamine for itch
- Stay off school/nursery until all spots have crusted (usually ~5 days after they appear)
- Avoid pregnant women, newborns and immunosuppressed people until crusted
Refer / follow-up
- Neonates, pregnant, immunocompromised, complications → same-day specialist advice
| Drug | Dose | Duration / notes |
|---|---|---|
| Paracetamol BNFc ↗ | Child: dose by age/weight per BNFc; adult 1 g four times a day | As needed |
| Chlorphenamine (age 1 year+) BNFc ↗ | Dose by age per BNFc (adults 4 mg every 4–6 h, max 24 mg/day) | For itch, especially at night |
| Aciclovir (adults/adolescents within 24 h of rash; consider) BNFc ↗ | 800 mg five times a day | 7 days |
This is chickenpox. It usually gets better on its own in about a week. Use paracetamol, not ibuprofen, because ibuprofen can make skin infections worse. Keep them off nursery until all the spots have crusted over, and away from pregnant women and newborn babies. Come back straight away if the skin becomes red, hot and painful, or they become drowsy, stop drinking or struggle to breathe.
Come back / call 111 — or 999 if severe — if:
- Spots become red, hot, swollen or very painful
- Child is drowsy, floppy, not drinking, or has trouble breathing
- Bleeding into the spots or bruising
- Fever lasting more than 4 days or coming back
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
- Recommending ibuprofen
- Missing secondary group A strep infection
- Not asking about pregnant/immunosuppressed contacts
Revision practice. Work through a real or imagined case to rehearse the reasoning. It builds a model note to learn from. It doesn’t replace your judgement, your seniors or local guidance.
✎Blank clinic note template
Chickenpox — clinic note
Doses are typical doses drawn from the guidance above. Always confirm in the current BNF/BNFc and your local antimicrobial policy.