Pox blisters
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Chickenpox pustules are characteristic skin lesions that appear in the course of varicella (chickenpox) – an infectious disease caused by the varicella-zoster virus (VZV) of the herpesvirus family. The rash is one of the most recognizable symptoms of the disease and develops in stages – from small spots, through papules and vesicles filled with serous fluid, to pustules and crusts. Skin lesions most often appear on the trunk, face and scalp, but may also involve the mucous membranes of the oral cavity or the genitals. Chickenpox pustules are almost always accompanied by intense itching, which promotes scratching of the lesions and can lead to scarring and secondary bacterial skin infections.
Chickenpox blisters – what do they look like
Chickenpox pustules have a very characteristic clinical picture, which in dermatology is often described as a “polymorphic rash”. This means that lesions at different stages of development occur on the skin simultaneously.
The typical evolution of a single lesion proceeds through several stages:
- Macule (macula) – a small area of skin redness.
- Papule (papula) – an elevated inflammatory lesion.
- Vesicle (vesicula) – a lesion filled with clear serous fluid.
- Pustule (pustula) – a vesicle containing opaque contents.
- Crust (crusta) – the final stage of healing.
Chickenpox vesicles are often compared to “dewdrops on a rose petal” because they are transparent and surrounded by an erythematous halo. Over time the fluid in the vesicle becomes turbid and a pustule forms, which then dries into a crust.
The most common locations of chickenpox pustules are:
- the trunk (chest and back),
- the face,
- the scalp,
- the extremities,
- the mucous membrane areas.
A characteristic feature of the rash is its wave-like pattern – new pustules appear over several days, so fresh vesicles and already healing crusts are visible on the skin at the same time.
Pox pustules – first pustules
The first chickenpox lesions usually appear 10–21 days after infection with the Varicella-zoster virus, that is, after the incubation period of the disease. In many patients the rash is preceded by general symptoms such as:
- elevated body temperature or fever,
- malaise,
- headache,
- weakness,
- loss of appetite.
At first small red spots appear on the skin, which within a few hours turn into papules and then into fluid-filled vesicles. The first lesions are most often observed on the trunk and face, from where the rash gradually spreads to other parts of the body.
In children the rash may be more pronounced, however the course of the disease is usually milder than in adults. In adults and in patients with weakened immunity the lesions may be more numerous and accompanied by a stronger skin inflammatory reaction.
It is worth emphasizing that a patient with chickenpox is most contagious from about 1–2 days before the rash appears until all the lesions have dried and crusted over.
Chickenpox blisters – what to apply
Treatment of chickenpox pustules is primarily symptomatic, because in most cases the disease resolves spontaneously. The aim of therapy is to reduce itching, prevent bacterial superinfections, and accelerate the healing of skin lesions.
The most commonly used preparations are:
Itch-relieving preparations
- preparations containing zinc oxide that act as drying and anti-inflammatory agents,
- dermatologic suspensions (so-called "liquid powders"),
- cooling gels containing menthol or panthenol.
Antiseptic preparations
- solutions with disinfectant/antiseptic action,
- topical preparations containing octenidine or chlorhexidine.
Antihistamines
- used orally to reduce skin itching.
In the past gentian violet (crystal violet) was commonly used, but this practice is now being abandoned because the preparation makes it difficult to assess skin lesions and may excessively dry the skin.
Care measures are also very important:
- keeping nails short to reduce the risk of scratching,
- wearing breathable cotton clothing,
- gentle skin hygiene without strong detergents.
Chickenpox blisters – how long do they itch?
Skin itching is one of the most troublesome symptoms of chickenpox. It is associated with the inflammatory process occurring in the skin and with irritation of nerve endings within the blisters and pustules.
The greatest intensity of itching is observed in the phase of blister and pustule formation, usually between the 2nd and 5th day of the illness. During this period, successive waves of new lesions appear on the skin.
The course of itching can be divided into several stages:
- the first 2–3 days of the rash – new lesions appear and the itching is very intense,
- the following days – some blisters turn into pustules and scabs, and the itching gradually decreases,
- the healing period – the itching subsides as the scabs fall off.
Usually the complete disappearance of itching occurs after 7–10 days from the appearance of the first pustules, that is, when all lesions have dried into scabs.
Scratching the lesions increases the risk of:
- secondary bacterial skin infections,
- development of acne-like or atrophic scars,
- post-inflammatory hyperpigmentation.
Therefore, especially in children, it is recommended to use anti-itch preparations and appropriate skin care during the illness.
