How to Identify Chickenpox Symptoms and Stages

Chickenpox appears as itchy red bumps that swiftly evolve into blisters, which can then turn into scabs within days. Early recognition is key to managing chickenpox, minimizing discomfort, and reducing contagiousness to protect those around you.

Early Signs of Chickenpox Before the Rash

Chickenpox is a viral infection that spreads easily from person to person. Symptoms typically develop anywhere from 10 to 21 days after exposure.

A person with chickenpox is contagious for up to two days before the telltale rash develops.

The phase that begins four to six days after exposure is called the prodromal phase, which is the period between initial symptoms and full development of the rash. During this stage, the virus moves from the respiratory tract or eyes to the lymph nodes.

From there, the virus spreads to the bloodstream, which is referred to as primary viremia. This triggers initial flu-like symptoms, such as:

• Headache
• Nausea
• Muscle aches
• Malaise, or a feeling of being unwell
• Runny nose
• Cough

These symptoms may last for a few days. Even before a chickenpox rash is visible, nasal secretions, saliva, and even teardrops are highly infectious.

How the Rash Starts and Spreads

As soon as 10 days after exposure, the virus reaches the outer skin layer, or epidermis, spreading through tiny blood vessels.

The rash consists of small, raised pink or red spots called papules. They usually start on the belly, back, or face, then spread over the whole body, including the scalp, arms, and legs.

The following are common characteristics of chicken pox.

Rash Distribution

Chickenpox can spread to parts of the body that are not usually affected by infections, such as the palms, soles, eyelids, mouth, and genitals. The rash emerges in waves over four to five days.

Mouth Sores

Even before blisters appear on the skin, chickenpox can break out in the mouth. This is called enanthem. The sores often look like tiny grains of white sand inside a red ring.

Chickenpox enanthem can be very painful and make it hard to eat. A topical oral pain reliever may help, and opt for soft or cooling foods like ice pops, milkshakes, or smoothies. Avoid spicy or acidic foods like tomatoes and citrus.

Early Chickenpox on Darker Skin

Chickenpox sores don’t appear quite as red on darker skin tones. The exact shade of red will depend on the skin tone. The sores will be bumpy and itchy.

What Happens When Blisters Appear?

After about 12 hours, the red bumps begin to turn into fluid-filled blisters known as vesicles. People often describe the rash as a “dew drop on a rose petal.” That’s because the blisters look bright, symmetrical, and almost see-through.

These blisters will be itchy, but it’s best not to scratch them. That’s because the blister and the fluid inside are highly contagious, and scratching can spread the virus, cause scars, or lead to infections.

During this phase, people often have a low-grade fever. It can usually be treated with Tylenol (acetaminophen).

Chickenpox Blisters on Darker Skin

Blisters will appear as skin-colored fluid-filled bumps. They may appear reddish on lighter skin tones.

Progression From Blisters to Scabs

Chickenpox blisters move on to the scabbing stage, although it’s important to keep in mind that the blisters typically arrive in waves and appear at various stages.

As blisters break open, the sores crust over as they heal. These sores appear as dry, crusty scabs on the skin.

During this stage, the disease gradually becomes less contagious, and healing begins.

Preventing Infected Chickenpox Sores

If chickenpox sores become infected, they may begin leaking pus or areas of the body may become red, warm, or tender.

Staphylococcal or streptococcal bacteria can lead to:

These secondary infections are not common. When they develop, they can sometimes spread into the bloodstream. The result can be a life-threatening condition known as sepsis.

A secondary skin infection may be treated with a topical, oral, or injected antibiotic, depending on how severe it is. Cellulitis may need intravenous (IV) antibiotics and fluids given in the hospital.

You can reduce the risk of a secondary infection by washing your hands regularly with soap and trimming your nails. Avoid touching any open or crusted lesions.

Chickenpox Scars

Chickenpox blisters don’t usually leave scars, but they’re more likely to if they’re scratched or become infected.

Scars appear dark on light skin and light on dark skin. They may look like round indentations on the skin.

While scars that appear darker can fade over time, indentations on the skin may last. If you want to improve the appearance of a scar, a dermatologist can suggest options, such as laser treatments.

How to Prevent Scarring

Trying not to scratch is the best way to avoid scarring. To reduce itching, try:

• Oatmeal baths
• Calamine lotion
• Benadryl (diphenhydramine), which helps with itching and sleep
• Trimming the fingernails 
• Cooling the skin with a cold, moist cloth
• Wearing mittens or soft socks on the hands
• Wearing loose-fitting cotton clothes
• Keeping the bedroom cool at night

When you bathe, use a mild soap. Blot rather than rub the skin dry with a towel.

When to See a Healthcare Provider

Chickenpox can usually be managed at home, and to prevent passing on the infection, it’s best not to go to a doctor’s office unless you need to. Contact your healthcare provider, though, in the following cases:

• Your child is under 1 year of age.
• Your teen has chickenpox.
• One lymph node is enlarged and tender.
• Fever persists for more than four days or returns after being gone for more than a day.
• Yellow pus drains from scabs or sores.
• After day six, new chickenpox appear.

Seek emergency care if your child shows excessive signs of illness, such as face swelling, trouble breathing, unsteady gait, eye pain, or a fever higher than 104° F (40° C).