Varicella treatment

Acute, uncomplicated varicella in the young child is managed best by topical antipruritics such as calamine lotion, application of cool compresses, or by oatmeal baths. Children’s fingernails should be kept trimmed. Oral diphenhydramine sometimes is administered to help combat the intense itching. Clinicians should avoid the application of topical formulations that contain diphenhydramine while administering diphenhydramine orally; absorption of the medication through the skin can lead to toxic serum levels.

Although oral acyclovir has been shown to decrease both the number and the duration of skin lesions, the benefits are marginal, and its routine administration is not indicated for uncomplicated varicella. Exceptions to this rule are adolescents, adults, children who have immune deficiencies, and second or third cases in a household in which the first child’s case was severe. VZV is much less sensitive to acyclovir than is HSV, and treatment requires much larger doses.

Treatment of encephalitis may be beneficial, and it usually is offered for acute forms. Postviral cerebellar ataxia does not require acyclovir treatment. Secondary bacterial infection of chickenpox lesions usually is due to Gram-positive organisms; antibiotics that are active against staphylococci and streptococci should be administered.

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