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Questions from practice — Chickenpox and painful genital lesions

Question: My three-year old has chickenpox. I’ve been using calamine and that helps the spots on her body but she’s also got them on her genitals. They’re really sore and especially painful when she wees. What do you advise? I read on the internet that I could use some 2.5 per cent lidocaine. Can I buy some?

Chickenpox lesions appear initially on the head and trunk, and then spread to the limbs but it is not uncommon for them to extend to the mouth and genitals. In females, sores may develop on the vulva, which can distressing.

Several American hospital websites advocate the use of lidocaine 2.5 per cent for relief of pain but in the UK there is little information on this aspect of treatment.

Lidocaine 2.5 per cent is not available in the UK. A 2 per cent cream for vulval itching (Vagisil) is available but this is not licensed for children under 12 years. Non-proprietary lidocaine ointment 5 per cent is licensed for relief of pruritis vulvae and can be used in children but the manufacturers do not recommend it for chickenpox spots on genitalia because they have no data to support this indication.

Other measures that may provide relief include douching after urinating, sodium bicarbonate baths, applying cool compresses to the area, and protecting the area with nappy cream (eg, Sudocrem).

Treatment of chickenpox aims to relieve symptoms and limit scratching because this can lead to secondary bacterial infection. Paracetamol or ibuprofen if the sufferer has a fever. Oral sedating antihistamines such as chlorphenamine or cyproheptadine, can ease the itching and are helpful at night to reduce sleep disturbance.

There is little evidence to support the use of calamine or crotamiton although some people find them soothing. Loose fitting, smooth cotton clothing may minimise irritation of lesions. Fingernails should be kept short.

The child should be given plenty of fluids (to avoid dehydration). The child should be kept away from other children and at risk groups (pregnant women, immunocompromised, babies under four weeks, non-immune adults) until all the lesions have crusted over.

The customer should be reassured that although unpleasant, the lesions should begin to improve within a few days. However, she should watch for signs of bacterial superinfection (a common complication in young children), such as worsening redness, soreness and warmth around the spots and a high temperature (often after initial improvement). This may require antibiotics.

Although chickenpox is usually a mild illness complications such as ear infections, varicella pneumonia and encephalitis may occur. If the child’s condition worsens or she develops other symptoms (eg, earache, coughing, shortness of breath, confusion or drowsiness) she should be seen by a doctor.

 

Sarah Marshall, practising pharmacist, Aberdeenshire

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Citation: The Pharmaceutical Journal URI: 10983195

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