NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Ibuprofen and chickenpox – risk of serious skin reactions

Key messages

  • GGC paediatric chickenpox guideline recommends paracetamol if necessary for pain and pyrexia in chickenpox
  • GGC paediatric chickenpox guideline highlights that ibuprofen may be associated with adverse skin reactions during chickenpox
  • Be aware of the risk of serious skin reactions and avoid, where possible, prescribing or recommending  ibuprofen for children with chickenpox
  • Parents/carers looking for advice on the treatment of chickenpox should be advised that paracetamol is preferred for pain and pyrexia

 

A number of sources, including the GGC paediatric chickenpox guideline, NHS Choices (http://www.nhs.uk/) and NHS Inform  (https://www.nhsinform.scot/), recommend using paracetamol if necessary for pain and pyrexia in children with chickenpox. These sources do not recommend ibuprofen in children with chickenpox as it has been associated with a risk of serious skin reactions (primarily secondary bacterial skin infections). This risk is not highlighted in the BNF or BNF for children (BNFC).  Some manufacturers of paediatric preparations of ibuprofen state that ibuprofen should be avoided in chickenpox, therefore, this is listed in some but not all Patient Information Leaflets (PILs).

The evidence for the risk of serious skin reactions with ibuprofen in chickenpox comes mainly from case control studies. Although the majority of the studies document an association between ibuprofen and skin and soft tissue reactions in children with chickenpox, there are limitations to the available evidence including the presence of confounding factors and limited patient numbers.

The association of serious skin reactions with ibuprofen in chickenpox has been highlighted in the media recently, and therefore parents/carers may ask about the risks. Refer to the UK Medicines Information Q&A for a summary of the evidence and proposed mechanisms to explain how NSAIDs may promote bacterial skin complications.

 

Published 20/12/17