# Varicella and Chickenpox Skin Features

> Varicella and chickenpox skin features for NEET-PG Dermatology: centripetal crops of vesicles, complications, congenital varicella and post-exposure cover.

- Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/varicella-and-chickenpox-skin
- Exam / course: NEET-PG · Subject: Dermatology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: IADVL Textbook of Dermatology; Nelson Textbook of Pediatrics
- How to cite: "Varicella and Chickenpox Skin Features", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/varicella-and-chickenpox-skin

## Direct answer

Varicella, or chickenpox, is the primary infection with varicella-zoster virus, a DNA herpesvirus that spreads by respiratory droplets and skin contact. It produces an itchy eruption of vesicles that appear in successive crops with a centripetal distribution, so lesions at different stages coexist. The virus then lies latent in sensory ganglia and can reactivate decades later as herpes zoster.

## What you must remember

- **Causative virus:** varicella-zoster virus, which causes primary varicella and later reactivates as herpes zoster.
- **Distribution:** centripetal, starting on the face, scalp and trunk and spreading toward the limbs, with the palms and soles usually spared.
- **Lesion pattern:** pleomorphic crops of macules, papules, vesicles, pustules and crusts appear together, so lesions at different stages are seen in one area.
- **Major complications:** secondary bacterial infection with group A streptococcus or Staphylococcus aureus, varicella pneumonia (especially in adults), cerebellar ataxia and encephalitis.
- **Reye syndrome:** aspirin is avoided in children with varicella because of its association with Reye syndrome.
- **Congenital varicella:** maternal infection before about 20 weeks of gestation can cause limb hypoplasia, cicatricial skin scars and neurological or ocular damage.
- **Post-exposure prophylaxis:** varicella-zoster immune globulin is given to high-risk susceptible contacts, ideally within 10 days of exposure.

## A pathway for a vesicular rash in a child

Chickenpox is common, so the examiner's focus is on recognising it and deciding which patients need extra care. The steps below follow the order a clinician uses at the bedside.

1. **Recognise the pattern:** crops of itchy vesicles spreading centripetally, with lesions at different stages in the same area, confirm the diagnosis.
2. **Identify high-risk patients:** adults, pregnant women, neonates, immunocompromised patients and those with lung disease need closer assessment, and oral aciclovir is considered early.
3. **Control itch and skin care:** calamine lotion and an oral antihistamine are used, and nails are kept short to limit secondary bacterial infection.
4. **Avoid aspirin:** paracetamol is used for fever, because aspirin is linked with Reye syndrome in children.
5. **Isolate the patient:** the patient is kept away from susceptible contacts until all lesions have crusted.
6. **Protect the contacts:** susceptible pregnant women, neonates and immunocompromised contacts receive varicella-zoster immune globulin, and vaccination is an option for other susceptible contacts within a few days of exposure.

## Where the exam plants its traps

Stems on varicella test the distribution, the complications and the management of pregnancy and exposure.

- **Trap:** calling vesicles at different stages impetigo or herpes zoster — **Correct:** chickenpox has crops of lesions at different stages with a centripetal spread, whereas zoster is unilateral and dermatomal.
- **Trap:** giving aspirin for fever in a child with chickenpox — **Correct:** aspirin is linked with Reye syndrome, so paracetamol is the antipyretic of choice.
- **Trap:** assuming that maternal chickenpox at 30 weeks causes congenital varicella — **Correct:** congenital varicella is mainly linked with infection before about 20 weeks, while infection near delivery threatens severe neonatal disease.

## Frequently asked questions

### What is the distribution pattern of chickenpox lesions?

Chickenpox lesions have a centripetal distribution, starting on the face, scalp and trunk and spreading toward the limbs. Lesions appear in successive crops, so macules, papules, vesicles, pustules and crusts coexist in the same area of the skin.

### Which drug should be avoided for fever in chickenpox and why?

Aspirin should be avoided for fever in chickenpox in children because it is linked with Reye syndrome, which causes liver failure with encephalopathy. Paracetamol is used instead to control fever in a child with varicella.

### What is congenital varicella syndrome?

Congenital varicella syndrome follows maternal varicella infection before about 20 weeks of gestation, and it can cause limb hypoplasia, cicatricial skin scars and neurological or ocular damage. Maternal infection close to delivery instead threatens severe neonatal varicella.

### Who should receive varicella-zoster immune globulin after exposure?

Susceptible high-risk contacts, such as pregnant women without immunity, newborns of infected mothers and immunocompromised people, should receive varicella-zoster immune globulin. It works best when given as early as possible, ideally within 10 days of exposure.

### Why is varicella more dangerous in adults than in children?

Varicella is more dangerous in adults because they have a higher risk of varicella pneumonia and encephalitis. Children usually recover without complication, so adults with chickenpox warrant closer assessment and early consideration of antiviral therapy.