Understanding The Difference Between Chickenpox And Shingles

Shingles and chickenpox are two commonly confused diseases. The varicella-zoster virus causes both, and they exhibit similar signs and symptoms, hence the confusion. But despite these similarities, both diseases are different.

Also, many think that chickenpox only affects kids and shingles only affects adults, but this is not entirely true. This post discusses shingles vs. chickenpox, its causes, similarities, and differences.   

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What is chickenpox?

Chickenpox is a highly contagious disease that is easily transmitted from one person to the other through bodily fluids or the air. Like shingles, chickenpox is caused by the varicella-zoster virus transmitted from one sick person to another through mucus, blisters, and saliva, as well as through airborne spread.

An infected person can also pass on the disease through coughing, sneezing, or breathing out viral particles while talking, breathing, or singing.

The virus is detectable a day or two before the rash, indicating you are likely infectious before the onset of the rash. Those with chickenpox will likely remain infectious for at least five days and until all lesions have crusted over. The incubation period is about 14 days, though it can be 10-21 days.

Chickenpox typically has a vesicular rash that is pruritic and appears in successive crops over days. The lesions are initially macules, then progress to papules and eventually vesicles. The vesicles then can develop a pustular component and crust over.

Patients may have lesions in different stages of development on different parts of the body. Typically, new vesicle formation stops around day four and lesions mostly crust over by day six. Crusts will ultimately fall off within a week or two.

What are shingles?

Like chickenpox, shingles are caused by the varicella-zoster virus. The virus is highly infectious to those who have never had chickenpox and also affects people who have had chickenpox. 

In people that have had chickenpox, the virus is never fully cleared — instead, it lays dormant in nerve tissue. In some cases, the virus can get reactivated to cause shingles. You can get it more than once, but only if you have had chickenpox or been vaccinated against it. If you had chickenpox as a child, you are at risk of getting shingles. 

If someone who has never had chickenpox comes in contact with the fluid from your shingles, they can develop chickenpox.

Chickenpox vs. shingles signs & symptoms

Unlike chickenpox, shingles rash forms on a single stripe of blisters on one side of the torso in the innervation area of a single nerve ganglion termed a dermatome. Both diseases can make you uncomfortable, but while chickenpox gives you an uncomfortable itch, shingles develop into excruciating blisters. 

The following symptoms should tell you whether it's shingles or chickenpox.

Shingles signs & symptoms

  • Fever

  • Headache

  • Fatigue

  • Blisters filled with fluid that later break into scabs

  • An intensely painful numbness

  • Rash limited to a dermatome that does not cross the midline

Chickenpox signs & symptoms

  • Fever

  • Headache

  • Loss of appetite

  • Tiredness and malaise

  • Rash throughout the body

Chickenpox vs. shingles vaccine

There are two vaccines for chickenpox: the Varivax vaccine, given in two doses, and the MMRV vaccine, a combination of measles, mumps, rubella, and varicella.

Varivax vaccine is available for children over one and adults and can be given to children for their first two doses. The MMRV vaccine is for children aged 12 months to 12 years.

On the other hand, shingles have a vaccine called Shingrix which is given in two doses to adults 50 years and over or adults over 18 that are immunosuppressed. The vaccine is highly effective, preventing shingles and postherpetic neuralgia, a complication of shingles, almost 90% of the time.

Shingles vs. chickenpox risk factors

Chickenpox has been common in the prevaccine era, with almost 95% of adults in the US having had it before 20 years of age. However, with the advent of vaccines, the incidence has declined by over 90%. 

Shingles, however, are most common in adults over 50. However, anybody who has had chickenpox or been vaccinated for it can contract shingles. The disease does not affect people who have never had chickenpox.

How to prevent shingles and chickenpox

You can prevent chickenpox and shingles by vaccinating your loved ones at the right time and using a suitable vaccine. In case there's a chickenpox outbreak, you can keep your family safe by:

  • Avoiding direct contact with the person affected, as well as ensuring appropriate ventilation and masking

  • Refraining from scratching the rash

  • Covering the rash

  • Washing your hands regularly

Shingles vs. chickenpox treatment options

You can relieve chickenpox symptoms and prevent skin infections at home by applying calamine lotion, adding baking soda to a cool bath, and using uncooked oatmeal to soothe the itching.

You can also prevent the infection from getting worse by keeping your fingernails trimmed and clean. If you accidentally scratch a blister, wash your hands with warm water and soap for at least 20 seconds. 

If you have to use over-the-counter medication, go for those without aspirin. Aspirin is known to cause Reye syndrome in children, a fatal disease that affects the liver and brain and can lead to death, especially in the context of a viral infection. In general, acetaminophen (paracetamol) is preferred to treat fever in children.

When to call a doctor

While you can try the above shingles and chickenpox treatment options at home, some situations require the intervention of a professional medical practitioner. Such situations include:

  • The patient is pregnant

  • The patient has never had chickenpox and is not vaccinated

  • The patient has a weakened immune system due to various reasons such as cancer, HIV/AIDS, has had a transplant, is undergoing chemotherapy, is on long-term use of steroids, or is under immunosuppressive medication

The healthcare provider will know the proper medication to administer depending on the patient's situation. 

Chickenpox vs. shingles common misconceptions

There are a lot of misconceptions about chickenpox and shingles. Still, the most common are:

  • Chickenpox and shingles are the same diseases — as we have seen, the same virus causes both diseases, and some of their symptoms are similar. Still, they are two different diseases, each with its risk factors and different vaccines.

  • Shingles are uncommon — contrary to this assumption, half of the American population who live to 85 will contract shingles at least once in their lifetime.¹

  • Shingles are for older people — children and younger people can contract shingles, especially if they have a weakened immune system, though this is relatively uncommon.

The lowdown

Shingles and chickenpox are two closely related diseases, given that the varicella-zoster virus causes them both. They can both transmit VZV from one person to the other through body fluids or airborne mechanisms. Other common symptoms include fever, headache, and fatigue

Chickenpox is milder than shingles. It can affect people of all ages, but it's more common in children. Shingles happen in people who have had chickenpox or been vaccinated, whereby the virus lays dormant in the body only to reactivate years later.

The good thing is that both diseases are preventable through vaccination. You can also prevent infection by avoiding direct contact with the infected person in case of a chickenpox outbreak and ensuring appropriate airborne precautions. Now that you know how the two affect you and how you can prevent them, consider protecting yourself and your loved ones through vaccination. 

  1. Shingles myths and facts | National Foundation of Infectious Disease

Other sources:

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