Chickenpox — medically varicella — is the first infection with the varicella-zoster virus (VZV), a member of the herpesvirus family. Typical is an intensely itchy rash of small blisters that spreads over the whole body. The German name, Windpocken (“wind pox”), comes from the way it is transmitted: the virus spreads through the air and can infect people even several metres away.¹
Anyone who has had chickenpox is, as a rule, protected for life against getting chickenpox again. The virus does not disappear, however: it retreats into nerve ganglia and can flare up again decades later as shingles — more on this in section 9.¹
In healthy children, chickenpox is usually unpleasant but harmless. It becomes serious above all for adults, pregnant women, newborns and people with a weakened immune system. Since the German Standing Committee on Vaccination (STIKO) began recommending the vaccination for all children, cases in Germany have become much rarer.¹,²
2. Course in children, adults and risk groups
How severe chickenpox is depends less on the virus than on who it affects.¹,³
Group
Typical course
What to watch out for
Healthy children
Mild fever, intense itching, crusted over after about a week
Avoid scratching and bacterial skin infections
Teenagers and adults
Often considerably more severe, more blisters, higher fever
Pneumonia is more common — especially in smokers
Pregnant women
More severe illness possible, especially with lung involvement
Risk to the unborn child; tell your doctor immediately, even after contact alone
Newborns
Dangerous if the mother falls ill shortly before or shortly after the birth
Prompt treatment needed
Weakened immune system
Severe, widespread illness with organ involvement possible
Early antiviral treatment, often as an infusion
After vaccination (“breakthrough”)
Usually mild: few blisters, often without fever
Still contagious — avoid contact with people at risk
Table scrolls to the right
Chickenpox during pregnancy
If a pregnant woman without immunity falls ill in the first half of pregnancy, the unborn child can develop fetal varicella syndrome, with damage to the skin, eyes, nerves and skeleton. The overall risk is low, but the consequences can be severe. If the mother falls ill in the days around the birth — roughly five days before to two days after — the newborn is at risk of a life-threatening infection.¹ The rule is therefore: if you are pregnant, have had contact with chickenpox or shingles and do not know for certain whether you are protected, call your practice straight away. There is only a short window for protective antibodies to be given (section 8).
3. Symptoms and complications
It often starts with a mild fever, headache and fatigue. Within a day, the typical rash appears:¹,³
Red spots, then small bumps, then blisters — filled with clear fluid that later turns cloudy and dries into crusts.
“Starry sky” — because new blisters keep appearing in waves, you see spots, blisters and crusts side by side at the same time. This is an important distinguishing feature.
Everywhere — usually starting on the trunk and face, then also on the hairy scalp and on mucous membranes such as the mouth or genital area.
Intense itching — the most distressing symptom, especially at night.
After about a week, all the blisters have usually crusted over. The crusts then fall off; scars remain mainly where there was scratching or where blisters became infected.
Possible complications
Bacterial skin infections — the most common complication, usually from scratched blisters.¹
Pneumonia — considerably more common in adults than in children, and pregnant women are particularly at risk; see pneumonia.¹
Nervous system — rarely, inflammation of the cerebellum with unsteady gait, meningitis or encephalitis.¹
Get medical help immediately — for breathing difficulties or impaired consciousness, call 112 (emergency number in Germany). Shortness of breath, a cough with chest pain, marked drowsiness, seizures, an unsteady gait or a stiff neck need the emergency department straight away. Just as urgent: a high fever returning after an initial improvement, and a patch of skin that quickly becomes red over a spreading area, hot, swollen and very painful — this can be a serious bacterial infection. Blisters on or in the eye must be seen by an eye specialist the same day. See also fever.
4. Transmission, incubation period and medicines
Transmission: mainly via virus-containing droplets in the air, and also via the fluid in the blisters — including from shingles. Almost everyone without protection who has close contact becomes infected.¹
Incubation period: usually 14 to 16 days, possibly 10 to 21 days; up to 28 days after antibodies have been given.¹
Contagious phase: from one to two days before the rash begins until all blisters have fully crusted over, typically five to seven days after the rash starts.¹
Weakened immunity due to medicines: people receiving immunosuppressants, chemotherapy, biologics or higher-dose cortisone over a longer period often become considerably more ill. This also applies, for example, to methotrexate for rheumatoid arthritis or psoriasis.¹,³
Are you taking medicines that suppress the immune system and have had contact? Contact your practice straight away, even without symptoms — do not wait until blisters appear. If you do not have reliable protection, preventive treatment is often still possible; there are only a few days to do this. However, do not stop your long-term medication on your own: this can be dangerous, especially with cortisone — see Stopping cortisone.
5. Diagnosis
Chickenpox is usually a diagnosis made at a glance: the “starry sky” rash is so typical that tests are rarely needed.¹
Call ahead: mention the suspicion over the phone. Many practices give children with chickenpox appointments at the edges of surgery hours so that no one in the waiting room is infected — such as pregnant women or people with weakened immunity.
Looking at skin and mucous membranes: distribution and stages of the blisters, signs of a bacterial infection, involvement of the eyes.
Detecting the virus: if the picture is unclear, during pregnancy or with weakened immunity, fluid from the blisters is tested for the virus in the laboratory.¹
Antibody test: it shows whether someone is already protected — useful, for example, when planning a pregnancy or before immunosuppressive treatment.
Telling it apart: insect bites, hand, foot and mouth disease, impetigo or extensive herpes can look similar.
Medication list: which medicines does the sick person take — and is anyone in the household taking immunosuppressants or pregnant?
A general overview of rashes can be found in the article Skin rash.
6. Treatment: itching, fever, antivirals
In healthy children, chickenpox heals on its own. Treatment aims to make the itching bearable, bring down the fever and prevent complications. A medicine against the virus is mainly given to people at increased risk. Which treatment suits the individual case is decided by the treating practice.¹,³
BasicsRelieve itching, avoid scratching
Cooling and loose clothing
Cool, damp compresses, airy cotton clothing and a bedroom that is not too warm. A short lukewarm shower is fine; afterwards, gently pat the skin dry.
Short fingernails, cotton gloves at night
Scratched blisters are the main route for bacterial infections and scars — in young children this is the single most effective measure.
Lotions and gels
Zinc-containing shake lotions or gels with polidocanol are often used and feel pleasantly cooling. There are hardly any robust studies on their benefit — they bring relief, but they are not a treatment.
Oral antihistamines
Can dampen the itching somewhat; older active ingredients such as dimetindene also cause drowsiness, which can be welcome at night. The evidence is limited, and doses for children depend on age and weight.
FeverBring down fever and pain
Paracetamol
The medicine of choice for chickenpox. For children, paracetamol is dosed according to body weight; do not exceed the maximum daily dose stated in the package leaflet.
No aspirin, avoid ibuprofen where possible
Acetylsalicylic acid is off-limits for children and teenagers with chickenpox, and the Summary of Product Characteristics advises against ibuprofen — details in the next section.⁴
Risk groupsAntiviral treatment
Aciclovir or valaciclovir as tablets
Considered for teenagers and adults, for severe illness and for certain underlying conditions — most effective when started early, ideally within 24 hours of the rash beginning.³ In healthy children the benefit is small, so as a rule they are not given the medicine.
Aciclovir as an infusion
For a weakened immune system, severe complications or newborns — usually in hospital.¹
More about the active ingredient and how to take it can be found in the article on aciclovir.
7. Aspirin, ibuprofen, cortisone: what to watch out for
No aspirin for children and teenagers
In children and teenagers with chickenpox or flu, acetylsalicylic acid (aspirin) can trigger Reye's syndrome — rare but life-threatening damage to the liver and brain.⁴ Acetylsalicylic acid is also contained in some combination products for colds and headaches, so it is worth checking the active ingredient. For the same reason, the Summary of Product Characteristics for varicella vaccines advises avoiding salicylates for six weeks after vaccination.⁵ If a child takes aspirin long-term for medical reasons, the approach is agreed with the practice in advance.
Why ibuprofen is advised against
In rare cases, chickenpox leads to severe bacterial infections of the skin and soft tissues. Whether anti-inflammatory painkillers such as ibuprofen contribute to this has not been clearly established — but a link cannot be ruled out, and they can mask early warning signs of an infection. The Summary of Product Characteristics therefore recommends avoiding ibuprofen in chickenpox.⁴ To be honest, the data are thin, and experts disagree on this. But as long as paracetamol is enough, there is no reason to take the risk.
Cortisone and immunosuppressants
Anyone taking cortisone, methotrexate, biologics or other immunosuppressive medicines long-term should inform their practice straight away if chickenpox is suspected or after contact. Creams containing cortisone should not be applied to chickenpox blisters either, unless the practice expressly prescribes them. More on the basics in the cortisone guide.
Do not stop long-term medication on your own. Fear of a severe course is understandable, but abruptly stopping cortisone or immunosuppressants can itself become dangerous — with cortisone up to adrenal insufficiency, with other medicines up to a flare-up of the underlying disease. Whether to pause, reduce or continue is decided by the practice. Background in the guide Stopping medications.
Taking aciclovir correctly
Aciclovir tablets have to be taken several times a day, up to five times a day depending on the regimen — spread as evenly as possible over the day, with enough fluid and for the whole prescribed duration. Valaciclovir needs fewer doses. If kidney function is reduced, the practice adjusts the dose.
Aciclovir five times a day? Don't miss a dose
brite reminds you of every dose and checks whether the antiviral is compatible with your other medicines.
The chickenpox vaccine is a live vaccine containing weakened viruses. STIKO, the German Standing Committee on Vaccination, recommends it for all children:²
First vaccination at 11 months: at the same time as the measles, mumps and rubella (MMR) vaccination, but at a separate injection site — or at least four weeks afterwards.
Second vaccination at 15 months: a four-in-one combination vaccine (MMRV) can be used for this. It is not preferred for the first dose, because febrile seizures were observed somewhat more often with it.
Catching up: children and teenagers who have not been vaccinated and have not had chickenpox should receive two doses as soon as possible.
Adults without immunity: recommended, among others, when planning a pregnancy, before planned immunosuppressive treatment and for people working in healthcare or childcare — more under Vaccinations for adults.
Unlike for measles, there is no compulsory vaccination against chickenpox. After two doses, illness is rare; if chickenpox does occur, it is usually mild.¹
Live vaccine: not during pregnancy and not with severely weakened immunity. After vaccination, pregnancy should be avoided for a period specified in the Summary of Product Characteristics.⁵ If you are taking immunosuppressive medicines or planning such treatment, clarify the right timing with your practice — often vaccination is only possible before treatment starts. More in the guide Vaccines and medications.
After contact: use the window of time
Post-exposure vaccination: unvaccinated people who have not had chickenpox can be vaccinated within five days of contact — or within three days of the rash starting in the sick person. This can prevent the illness or make it milder.¹
Antibodies (varicella-zoster immunoglobulin): for people who must not be vaccinated and are at high risk — pregnant women without protection, people with weakened immunity, certain newborns. They should be given as early as possible, at the latest after 96 hours.¹
9. Chickenpox and shingles: one virus, two diseases
After chickenpox, the varicella-zoster virus stays in nerve ganglia for life, close to the spinal cord. If the immune defences weaken — with age, with serious illnesses or under immunosuppressive medicines — it can travel along a nerve to the skin. This is shingles (herpes zoster): a painful, band-shaped blistering rash, usually on one side.¹
Chickenpox
Shingles
What happens?
First infection with VZV
Reactivation of the dormant virus
Who?
Mostly children without immunity
Mostly older people or those with weakened immunity
Rash
All over the body, intensely itchy
On one side, band-shaped, often with burning pain
Transmission
Through the air and via the blister fluid
Via the blister fluid; people without protection then get chickenpox
Vaccination
Live vaccine, two doses in early childhood
Separate inactivated vaccine for older and at-risk adults
Table scrolls to the right
Important for everyday life: shingles is not passed on as shingles. But anyone who has not yet had chickenpox and is not vaccinated can become infected from the blisters of someone with shingles and then gets chickenpox. The vaccine virus can also remain in the body; according to the data so far, however, shingles occurs less often afterwards than after a natural infection. The shingles vaccine is a different vaccine with its own age recommendation — the details are in the article on shingles.
10. Everyday life: nursery, school and notification
Stay at home: under § 34 of the German Infection Protection Act (IfSG), which regulates exclusion from and readmission to childcare and schools, children with chickenpox may not attend nursery (Kita) or school. If the illness is uncomplicated, they may go back once all blisters have fully crusted over — as a rule about a week after it started.¹
Inform the facility: the nursery or school needs to know; it reports cases to the local public health office (Gesundheitsamt).
Notification requirement: doctors report even a suspected case of chickenpox to the public health office by name, and laboratories report detection of the virus.¹
Protect people at risk: no contact with pregnant women without reliable protection, newborns or people with weakened immunity as long as the blisters have not crusted over.
Fever medicine by weight: always dose for children according to body weight, and no aspirin. Tips in the guide Medications for children.
Check your medicine cabinet: paracetamol syrup, a thermometer, a cooling lotion — what is still missing is shown in the home pharmacy checklist.
When was the last dose of fever medicine?
When several children are ill or parents take turns: record doses and temperature so that everyone can follow them.
Contagiousness begins one to two days before the rash and ends when all blisters have fully crusted over. This is typically the case five to seven days after the rash begins. The incubation period until the first symptoms is usually 14 to 16 days.
If the illness is uncomplicated, as soon as all blisters have fully crusted over. According to the Robert Koch Institute, Germany's national public health institute, this is usually about a week after the rash began. The nursery must be informed about the illness.
The Summary of Product Characteristics advises avoiding ibuprofen in chickenpox, because a link with rare, severe skin and soft tissue infections cannot be ruled out. The data are thin, but paracetamol is the medicine of choice for fever in chickenpox. Aspirin is off-limits for children and teenagers because of Reye's syndrome.
It is possible, but rare after two doses of the vaccine. Such breakthrough infections are usually mild, with few blisters and often without fever. They are still contagious, however, so the same rules apply for nursery and for contact with people at risk.
Shingles itself is not passed on. But anyone who has neither had chickenpox nor been vaccinated can become infected with the virus via the blister fluid and then gets chickenpox. Until all blisters have crusted over, the rash should be covered and close contact with unprotected people avoided.
If you do not know for certain whether you are protected, call your gynaecology or GP practice straight away. A blood test can clarify your immunity, and if you are not protected, antibodies can prevent the illness or make it milder. They should be given as early as possible, at the latest within 96 hours of the contact.
As a rule, no, because having had the infection leaves long-lasting protection against chickenpox. The virus remains in the body, however, and can return later as shingles. A supposed second bout of chickenpox is often a different skin condition or shingles that has spread unusually.
Robert Koch Institute (RKI): RKI guide on chickenpox (varicella) and shingles (herpes zoster). Accessed 2026 — German source. rki.de
German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute: STIKO recommendations, Epidemiological Bulletin, current version. Accessed 2026. rki.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. If there is shortness of breath, impaired consciousness, seizures or a rapidly spreading, painful reddening of the skin, call 112 straight away; pregnant women and people with weakened immunity should contact their practice promptly after contact alone. Do not give acetylsalicylic acid (aspirin) to children and teenagers with chickenpox. The choice of medicine and its dose are always set individually by the treating practice. Last updated: September 2026.
