Corticosteroids (chickenpox)

In general, chickenpox and corticosteroids do not mix:

• there are 10 fatalities per year from chickenpox associated with immunosuppression in the UK
  
  
• the risk is related to the dose of corticosteroid used
  
  
• there is an increased risk of severe herpes zoster when taking systemic corticosteroids
  
  
• physicians prescribing corticosteroids must identify the patients at risk:
  • all patients taking systemic corticosteroids (unless for replacement) who have not had chickenpox or herpes zoster
    
    
• physicians must take steps to minimise the risk in the group identified:
  • patients should be advised to take reasonable steps to avoid close personal contact with people with herpes varicella or herpes zoster
    
  • if one of the identified patients is exposed to chickenpox then the patient should receive passive immunisation with varicella-zoster immunoglobulin (VZIG)
    
    
• a patient who is exposed to chickenpox within 3 months of receiving systemic corticosteroids should also receive VZIG
  
  
• VZIG should be given within 10 days of exposure (preferably within 3 days)
  
  
• if a patient presents with fever and a systemic illness and is receiving systemic corticosteroids then a diagnosis of chickenpox should be considered
  
  
• if the diagnosis is confirmed then a specialist referral and urgent treatment (e.g. i.v. acyclovir) is warranted
  
  
• note that corticosteroids should not be stopped and may need to be increased

Reference:

• CSM. Current problems in pharmacovigilance (February 1994).
• Kasper WJ, Howe PM. Fatal varicella after a single course of corticosteroids. Pediatr Infect Dis J.1990;9 :729-732