Chickenpox
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- Small red spots on the scalp, face, trunk and upper limbs that quickly develop into vesicles, which are very itchy. Fever and general malaise may be present also
- There may be a prodromal phase of up to 3 days that includes nausea, myalgia, anorexia and headache (more common in adolescents and adults)
Chickenpox
Referral criteria
- Secondary bacterial infection of lesions (bacterial skin infections may present with clinical features such as weeping, oozing, crusting, pustules, erythema in tandem with systemic symptoms such as fever and malaise)
- Signs of dehydration include cold extremities, lethargy, low urine output, low skin turgor
- Patients who are more likely to suffer from complications or a severe infection (such as pregnant women, immunocompromised patients or neonates)
Time frame to resolution
- From the appearance of the first spots until all have crusted over will take around 7 days. Crusts fall off after 7-14 days
Management strategy
Non-pharmacological advice
- Maintain adequate fluid intake
- Dress appropriately to avoid overheating
- Keep nails short to minimise risk of breaking skin if scratching
- While the most infectious period is 24 hours before the rash appears, vesicles are infectious until they crust over; do not send child to school or nursery until all lesions have crusted over
- Avoid those who are pregnant, immunocompromised and infants aged 4 weeks or less
- Be wary of complications, such as superinfection or dehydration (see referral criteria)
Pharmacological advice
- Consider paracetamol (NOT ibuprofen or other NSAIDs) for children with fever who appear distressed or unwell; do not recommend for child with fever who is otherwise well
- Calamine lotion can be used to relieve itch
- Chlorphenamine can be used for itch associated with chickenpox in children 1 year of age or older
- Pregnancy: referral is a priority (you can provide relevant non pharmacological advice). Risk assessment: person's risk of chickenpox i.e. their personal history of chickenpox, the certainty of chickenpox in the contact, and the level of exposure
- NB: In terms of prevention, from January 2026 the chickenpox (varicella) vaccine is part of the routine NHS childhood vaccination schedule, given as a combined MMRV vaccine (measles, mumps, rubella, varicella). Children born on or after 1 September 2022 are offered 1 or 2 doses as part of their routine vaccinations. From 1 November 2026 to 31 March 2028, a single MMRV catch-up dose is offered to children born between 1 January 2020 and 31 August 2022 who have not previously had chickenpox or 2 doses of varicella vaccine. Chickenpox vaccination services are also available privately at several pharmacy chains in the UK