Chickenpox in children: symptoms, care, and prevention of spots on black and mixed-race skin

Chickenpox is a common and almost normal eruptive viral infection of childhood; as such, it is considered a usually mild condition. It nevertheless deserves special attention, especially when it affects infants and certain Black or mixed-race children whose skin reacts differently. There are risks of serious complications in adults, especially non-immunized pregnant women. At Zawadi, we know that every skin tells a unique story: understanding the specificities of Black or mixed-race children with textured hair allows for a better understanding, protection, soothing, and prevention of marks that may persist after chickenpox heals.

A. What is chickenpox?

Chickenpox is caused by the Varicella-Zoster virus (VZV), a member of the herpes family. Highly contagious, it is transmitted primarily through the respiratory tract or by direct contact with the spots. The virus is carried by droplets from respiratory secretions or the contents of vesicles of infected babies and children. The risk of transmission is highest before the eruptive phase of the disease, and this risk, particularly among non-immunized siblings, is greater than 80%, while it is just over 20% in group settings (daycare, kindergarten, etc.).

Once the virus has entered the body through the mucous membrane of the respiratory tract, it will migrate rapidly to the parapharyngeal lymph nodes, where it will replicate. After an incubation period of about 10 to 21 days, the child develops a moderate fever, headaches, and abdominal pain: the typical chickenpox rash will appear 1 to 2 days after these signs. These rashes usually start on the scalp, face, or trunk. They consist of erythematous macules that turn into clear-filled vesicles within a few hours, surrounded by an irregularly shaped erythema.

Figure 1: Typical chickenpox rash in an infant

Chickenpox is essentially a childhood disease; 50% of children will contract the infection before the age of 5, and more than 90% will contract it before they are 12. However, it should be noted that people from Africa or the French Overseas Territories (DOM-TOM) are less likely to have contracted the disease during their childhood and are therefore more susceptible in adulthood. People with Black and mixed-race skin are therefore at-risk individuals because they can develop the disease late.

Figure 2: Seroprevalence curve for chickenpox in the French population

B. Typical symptoms of chickenpox in children and babies

The classic signs appear in several stages:

• There is a mild to moderate fever that rarely exceeds 38 to 39 °C, sometimes preceded by fatigue or headaches;
• Then, small pink spots appear on the face and torso, which then spread to the whole body;
• These small spots quickly evolve into vesicles: tiny blisters filled with a clear liquid, which are very pruritic (the child has a strong urge to scratch);
• After 24–48 hours, the vesicles dry out, form a crust, and then fall off naturally after a few days;
• The rash evolves in successive waves: a child may therefore have red spots, blisters, and crusts at the same time for 1 to 7 days.

The disease ends with the falling off of the crusts, which leaves a transient depigmentation of the skin and sometimes scars, particularly on the forehead.

C. What are the specificities of chickenpox on Black and mixed-race skin?

On Black or mixed-race skin, the symptoms of chickenpox may appear different:

• The initial redness is less visible: the spots look darker, sometimes brownish or purplish;
• The inflamed areas may have gray or dark red undertones;
• After healing, the skin tends to mark more: post-inflammatory spots can persist for several weeks.

These marks are not classic scars: they are due to an excessive melanic reaction, with the skin producing too much or not enough melanin during the healing process.

To learn more about the physiology of children's skin, also see our article: Study on the characteristics of baby skin

D. What are the possible risks and complications of chickenpox?

In France, the sentinel network in charge of monitoring eruptive diseases estimated the complication rate for chickenpox at 4% in the early 2000s. A more recent study by several general practitioners estimates this rate between 7 and 8% in children under 13 years old and 10% in adolescents and adults. The most common risks and complications of chickenpox are:

• Bacterial infectious complications: they represent 50% of complications in children hospitalized due to chickenpox and are mainly the domain of children under 5 years old.
• Neurological complications: they represent 20% of the reasons for hospitalization related to chickenpox.
• Reye's syndrome: this is an acute encephalopathy accompanied by liver damage. You must never give aspirin to a child with chickenpox.
• Age: infants under 1 year old and non-immunized young adults are at a higher risk of severe forms.
• The presence of chronic skin lesions such as eczema can aggravate chickenpox.
• The use of corticosteroids, even inhaled, can promote severe forms.

E. What are the specificities of congenital chickenpox and newborn chickenpox?

Congenital chickenpox is rare but can lead to serious complications. The risk of developing varicella fetopathy for a pregnant woman with chickenpox is less than 3%. Regarding newborn chickenpox, we distinguish between:

• Perinatal chickenpox: occurs if the mother has chickenpox between 5 days before and 2 days after delivery. The baby can be infected within 10 days of birth.
• Infant chickenpox: if the mother is immunized, the baby is protected and shows a mild form.

F. Care and hydration during and after chickenpox

• Local hygiene: one or two daily showers with a gentle cleansing gel or a dermatological bar. Avoid baths to limit maceration.
• Soothing itching: an H1 antihistamine may be recommended.
• Do not scratch: keep nails cut short, wear cotton gloves at night.
• Moisturize after the crust phase: use a cream rich in moisturizing agents (ceramides, urea), for example, with our Moisturizing Milk specially developed for baby's sensitive skin.
• Never use talc or powder: this promotes maceration.
• Never give aspirin or NSAIDs (ibuprofen): use paracetamol in case of fever.
• To accelerate the healing process and make dark spots on the baby's or child's skin disappear quickly, consider applying a repairing treatment rich in precious date oil on the spotted areas.

After chickenpox, the skin remains fragile for several weeks. For children with Black or mixed-race skin, it is essential to avoid the sun. Use an SPF 50 sunscreen and anti-UV clothing to prevent the setting of pigment spots.

G. When to consult a doctor during chickenpox?

• Fever exceeds 39 °C or persists for more than 3 days;
• The spots become infected (cloudy liquid, thick crusts, pain);
• The baby or child has difficulty breathing or has intense headaches;
• The baby or child vomits more than twice in one day.

Chickenpox is generally mild, but medical follow-up remains recommended, especially for fragile children.