NSAIDs and chickenpox

I read with interest the editorial by Davis and Robson on the dangers of NSAIDs¹ and wanted to reinforce the need for better professional and public education surrounding their risks, especially those less frequently encountered. Having recently passed my medical school finals and the national Prescribing Safety Assessment I was initially dismissive of an article in the Daily Mail warning against the use of ibuprofen in children with chickenpox.²

In 6 years at medical school, numerous encounters with chickenpox, and my studies for both these exams this was not something I had ever heard of. A little research though confirmed that NHS Choices,³ both the patient⁴ and professional⁵ Patient UK articles, and the NICE Clinical Knowledge Summary⁶ all advise against the use of NSAIDs in children with varicella due to an association with an increased risk of severe skin and soft-tissue complications.⁷ It seems surprising, therefore, that in neither my time as a medical student nor as a patient have I been made aware of this risk.

The guidance is clearly available when sought, but with a drug such as ibuprofen that is so freely used and prescribed, perhaps this guidance should be better publicised.