Chickenpox in adults

Overview

Chickenpox is a common infection caused by the varicella-zoster virus. It causes an itchy rash with spots that turn into blisters. Most people get it as children, but adults can get it too. For adults, the illness is often more serious.

Chickenpox is less common in adults than in children because most adults have already had it as children. However, adults who never had it and are not vaccinated can still catch it.

Chickenpox can affect any adult who has not had the infection before or who has not been vaccinated. It is more serious in pregnant women, people with weakened immune systems, and older adults.

Symptoms

Common symptoms

• An itchy rash that starts as small red spots, then becomes fluid-filled blisters which eventually crust over
• Fever
• Feeling very tired or achy
• Loss of appetite
• Headache

Symptoms in children

• Mild fever
• Itchy rash that appears in crops over several days
• Tiredness and irritability
• Usually recover within a week

Symptoms in older adults

• Higher fever and more severe symptoms
• More extensive rash
• Higher risk of complications like pneumonia

Causes

Main causes

• Infection with the varicella-zoster virus. It spreads through droplets in the air when an infected person coughs or sneezes, or by touching the rash or fluids from the blisters.

Risk factors

• Never having had chickenpox as a child
• Not being vaccinated against chickenpox
• Having a weakened immune system (e.g., from cancer treatment, organ transplant, or HIV)
• Being pregnant

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above
• If you are pregnant and think you have been exposed to chickenpox
• If you have a weakened immune system and develop a rash or fever

Book a routine appointment if:

• If you are an adult with chickenpox and your symptoms are not improving after a few days
• If you are unsure whether you have chickenpox

Diagnosis

A doctor can usually diagnose chickenpox by looking at the rash and asking about your symptoms. The rash is very distinctive.

Tests that may be done

• Usually no tests are needed. In rare cases, if the diagnosis is unclear, a swab of fluid from a blister can be sent to a lab to confirm the virus.

What to expect at your appointment

The doctor will ask about your symptoms, when they started, and any exposure to chickenpox. They may also check your temperature and examine your skin. They will advise you on how to manage the illness and when to seek further care.

Treatment

Treatment for chickenpox in adults focuses on relieving symptoms and preventing complications. Most people recover at home. Antiviral medicines may be prescribed by a doctor in some cases, especially if started early or if you are at high risk for severe illness.

Self-care at home

• Get plenty of rest and drink lots of fluids to avoid dehydration
• Take paracetamol (acetaminophen) to reduce fever and pain – avoid ibuprofen and aspirin unless advised by a doctor
• Use calamine lotion or cool compresses to soothe the itch
• Keep fingernails short and try not to scratch to prevent skin infections
• Wear loose, soft clothing

Medical treatments

A doctor may recommend antiviral medicines for adults, especially if you are at higher risk of complications. These work best when started within 24 to 48 hours of the rash appearing. They are not a cure but can help reduce the severity and length of the illness. For severe cases, hospital care with intravenous fluids or breathing support may be needed.

When is surgery considered?

Not applicable. Surgery is not a treatment for chickenpox.

Living with this condition

If you have chickenpox, you will need to stay home from work and avoid contact with others until all the blisters have crusted over – usually about 5 to 7 days after the rash starts. This helps stop the virus spreading.

Lifestyle tips

• Stay away from people who are at high risk, such as pregnant women and those with weak immune systems
• Do not share towels, bedding, or clothes
• Wash your hands often
• Cover your mouth and nose when coughing or sneezing

Diet and exercise

Eat light, nutritious foods if you have an appetite. Drink plenty of water, herbal teas, or clear soups. Avoid strenuous exercise until you feel better – your body needs energy to fight the infection.

Mental health and emotional wellbeing

Being unwell and isolated can feel lonely or frustrating. The itchiness can also be distressing. It helps to talk to friends or family by phone or video call. If you feel very anxious or low, speak to your doctor.

Prevention

Yes. The chickenpox vaccine is very effective at preventing the infection. It is part of routine childhood vaccination in many countries. Adults who have not had chickenpox or the vaccine can still get vaccinated.

Vaccines

The chickenpox vaccine is given as two doses. It is recommended for adults who are at risk of exposure, such as healthcare workers, and those with weakened immune systems (with their doctor's advice).

Screening programmes

Screening is not needed. You can have a blood test to see if you are immune to chickenpox, especially if you work in healthcare or are planning a pregnancy.

Complications

If left untreated

• Pneumonia (lung infection) – more common in adults
• Encephalitis (swelling of the brain)
• Skin infections like cellulitis from scratching
• Dehydration from fever and reduced fluid intake
• In pregnancy, chickenpox can harm the baby

Long-term outlook

With good care and medical support when needed, most adults recover fully from chickenpox. Complications are not common, but they are more likely in adults, which is why it is important to see a doctor. The vaccine offers excellent protection.

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