When should I consider referring a patient with chickenpox for specialist evaluation?

Consider referring a patient with chickenpox for specialist evaluation in the following situations:

• Neonates (birth to 1 month old) with chickenpox should have immediate specialist advice sought due to increased risk of severe disease and potential need for intravenous aciclovir treatment.
• Immunocompromised patients with chickenpox require specialist advice because they are at higher risk of severe complications such as pneumonia, encephalitis, and disseminated intravascular coagulopathy, and may need close monitoring and antiviral treatment.
• Pregnant women with suspected chickenpox should be referred immediately for specialist evaluation, especially if they have respiratory or neurological symptoms, haemorrhagic rash, severe disease, or significant immunosuppression. Specialist input is also needed to assess fetal risk and consider antiviral treatment.
• Patients suspected of having serious complications from chickenpox (e.g., pneumonia, encephalitis) should be admitted or referred urgently for specialist care.
• If a high temperature develops after initial improvement, especially with redness and pain around lesions suggesting bacterial superinfection, specialist advice should be sought.

In all other cases without complications, symptomatic treatment and advice can be managed in primary care, but with clear instructions on when to seek further medical advice.

These recommendations are based on UK clinical guidelines and expert consensus to ensure timely specialist involvement for high-risk groups and complications ¹.