corticosteroids (chickenpox)

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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

Last reviewed 01/2018

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