The following article reminds Numark members and the pharmacy team about how to manage chicken pox.

Key finding - Ibuprofen should be avoided in chicken pox

Chicken pox is a common and mild childhood infection caused by the Varicella Zoster virus. Common symptoms of the condition include:

  • Vesicular rash
  • Fever
  • Malaise

Children will typically have been unwell for several days before the rash develops showing symptoms of headache, myalgia, nausea and loss of appetite - commonly referred to as prodromal symptoms.

Chicken pox is highly contagious with approximately 90% of susceptible contacts developing the disease. Infected individuals will be contagious from 1-2 days prior to development of the rash and will remain infectious until the rash has crusted over.

Treatment

Treatment of chicken pox is symptomatic using antipyretic and antipruritic agents.

Antipyretic agents will help to relieve pain and fever. NICE Clinical Knowledge Summary advises that paracetamol is the antipyretic agent of choice for patients with chicken pox. Ibuprofen should be avoided in chicken pox because of the potential link between the use of NSAIDs in children with varicella and an increased risk of necrotising skin reactions.

The Summary of Product Characteristics for Numark Ibuprofen 100mg/5ml oral suspension states:

“Exceptionally, varicella can be at the origin of serious cutaneous and soft tissues infectious complications. To date, the contributing role of NSAIDs in the worsening of these infections cannot be ruled out. Thus, it is advisable to avoid use of ibuprofen in case of varicella (chickenpox).”

Similar warnings appear in the SPC’s of other brands of ibuprofen 100mg/5ml suspension.

Antipruritic agents such as Chlorphenamine can be advised for children over 1 year to relieve the itch and discomfort whilst calamine lotion can also be recommended to relive the itch.

Self-help advice

Pharmacy staff can also provide parents or carers with the following self-help advice:

  • Avoid scratching the lesions as this can lead to scarring and secondary infection
  • Adequate fluid intake will help to prevent dehydration- ice lollies are useful where the child’s mouth is sore
  • Smooth cotton fabrics will be more comfortable to avoid overheating or irritating the skin
  • Keeping finger nails short will minimise any damage to the skin from scratching
  • Avoiding contact with patients at increased risk of the infection will help to reduce transmission

What you should do:

Pharmacy staff should also be alert to patients showing signs of secondary infection such as tenderness, pyrexia or erythema as this may require referral to the patients’ GP.

Chicken pox infection can be more complicated in adults, neonates, immunocompromised patients or pregnant women. These patients should be referred to their GP for advice or monitoring.

Reinforce the advice of not recommending ibuprofen for chicken pox and suggest using paracetamol instead. Please contact Information Services on 0800 783 5709 Option 2 (calls may be recorded for training purposes) if you need any clarification.

Further information on chicken pox can be obtained from:

NICE Clinical knowledge Summary-Chicken Pox

External Link

NHS Choices

External Link

Patient.co.uk

External Link