Chickenpox, Impetigo Or Hand, Foot And Mouth: How To Spot Difference

This article features expert advice from Dr Bisola Laguda, a paediatric dermatologist and spokesperson for the Skin Health Alliance.

With kids now getting extra protection against chickenpox as part of their routine childhood immunisations, it’s hoped fewer kids will end up struggling with the worst effects of the illness.

That said, kids might still catch it – albeit a milder version – and those who aren’t vaccinated against it (either because they’re too young or their parents opted out) will also be at risk.

But spotting chickenpox can be tricky, especially as the telltale sign is a rash – and other childhood illnesses like impetigo and hand, foot and mouth can look pretty similar.

To try and get some clarity on how to tell it apart from other illnesses, which is important so you know how to treat it (and how long they’ll need off school or childcare), we spoke to Dr Bisola Laguda, a paediatric dermatologist and spokesperson for the Skin Health Alliance.

Chickenpox is a very contagious infection caused by the varicella zoster virus. Data indicates that half of children will contract chickenpox by the age of four, and 90% by the age of 10.

Kids might initially experience flu-like symptoms, such as a high temperature and feeling sick and/or achy, said Dr Laguda.

“When the rash does manifest, it’ll be in the form of small red spots that blister and can become very itchy,” she said.

“These spots can appear in clusters anywhere on the body, but are commonly found on the arms, legs, chest and stomach, as well as the face, scalp and ears.”

It’s worth bearing in mind that new spots can appear around three to five days after the initial rash begins, too.

After a day or two, the blisters begin to burst and dry out, “with the crusting skin naturally falling off within two weeks”.

The dermatologist noted that whilst chickenpox can cause a lot of frustration and upset, children’s symptoms will often resolve themselves naturally.

But if the skin around the blisters becomes hot, red or painful; the blisters themselves get infected; or your child develops other symptoms such as dehydration, chest pain, or difficulty breathing, she said it’s best to contact your GP.

Never give ibuprofen to kids with chickenpox (unless told to by a doctor). Pharmacists can provide antihistamine medicine to try and ease any itching, while paracetamol can help with pain or discomfort.

Hand, foot and mouth disease (HFMD) is another unpleasant illness kids tend to pick up in the early years.

The first stage of symptoms typically involves a sore throat, high temperature and not wanting to eat. A few days later, kids develop a raised rash of spots and/or mouth ulcers.

There are some key distinctions that can help parents tell the two viral infections apart, said Dr Laguda.

“Both manifest in rashes, but appear on different areas of the body and have visual discrepancies,” she explained.

“Where chickenpox can appear anywhere, HFMD rash patterns are most commonly found on the palms of the hands, soles of the feet and inside the mouth – though it is true that we are seeing more cases of HFMD around the face and genitalia, so worth keeping an eye on these areas too.

“Also, chickenpox rashes appear as small, itchy blisters, whereas HFMD is usually characterised by flat, red spots.”

The illness usually gets better on its own. If symptoms don’t go after seven to 10 days, speak to your GP.

Impetigo is another contagious illness you probably won’t have heard of until your kids get it (I certainly hadn’t).

The skin infection starts off as red sores or blisters, which can then burst leaving crusty, almost cornflake-like golden brown patches. These can be itchy and/or painful.

Dr Laguda said it’s “important to be able to distinguish chickenpox from impetigo”.

“While impetigo is a bacterial infection and chickenpox is viral, both can cause itchy, blistery rashes. However, where chickenpox rashes are fluid-filled blisters potentially found across the entire body, impetigo appears as yellow-ish, crusty patches around the nose, mouth and limbs.

“It’s worth noting impetigo can develop secondary to chickenpox if blisters become infected after being scratched.”

Treatment typically involves hydrogen peroxide cream or antibiotic cream/tablets, so a trip to the pharmacist or your GP is warranted.