Viral Rashes/Exanthems

Viral Rashes/Exanthems

If you are worried your child may have a viral rash, you will want to get it evaluated by their physician.  If your child has been exposed to a virus, you will want to make your doctor aware when you make the appointment (it would not be safe to wait in the waiting room if, say your child had been exposure to measles, next to young babies or pregnant women who have not been vaccinated).  You will also want to make sure to vaccinate your baby and keep their vaccines on schedule.  By delaying vaccinates, you are putting your child at risk and also putting babies who are not old enough to receive vaccinations at risk.  We need to do our part as parents to keep our children and other children safe in our communities!



Measles is uncommon in developed counties because of the wide spread use of the MMR (measles-mumps-rubella) vaccine.  Although, this is still the case, we are starting to see cases here in the United States, due to parents deciding to not vaccinate their child.  Children usually get the MMR at their 12 month doctor well check.

Q. What causes measles?

Measles is due to the virus: paramyxovirus, which is very contagious.  The virus is spread through coughing, sneezing (virus can travel through the air) or sharing food and drinks.  Incubation period is from 8-12 days, this is when your child has been exposed, but has no symptoms.  After the incubation period, you will see tiredness, high fevers, cough, running nose, and clear eye discharge.  You will also see bluish-white spots in their mouth, called Koplik’s spots.  After 5 days of these symptoms, a rash will appear.  The rash will appear as a small, blotchy, red, raised and flat lesions rash that starts on their head at their hairline and will works its way down the body.  The rash will involve their palms and soles of their hands and feet.  Your child is contagious until 4 days after the resolution of the rash. This virus is usually seen in the late winter and early spring.

Q. What are the complications?

 Actue encephalitis or brain swelling, resulting in brain damage.  Pneumonia. Death.




Rubella is part of the MMR vaccinate and can be prevented by making sure your child gets their vaccine at their 12 month well check appointment.

Q. What causes rubella?

Rubella is caused the “rubella virus”.  This is spread from body fluids from the mouth, nose or eyes, or by coughing, sneezing (can travel through the air).  The incubation period for this rash is 14-21 days, then symptoms will occur.  You will see a low-grade fever, tiredness, swollen lymph nodes, headache, sore throat and watering eyes.  You will also see a rash that looks like very fine, red, flat and raised bumps over the body.  This rash will start on the face and move down the body.  Usually the rash will clear up by 72 hrs.  As many as 25% of people will have no symptoms, but still be able to pass on the disease.  Your child will be contagious until 3 days after the rash.  This virus is seen in the late winter and early spring.

Q. What are the complications?

Sore joints, blood abnormalities (low platelets), brain swelling.  Pregnant women infected are of major concern.  This can cause congenital rubella syndrome.  If you are pregnant and have been exposure, you will need to inform your doctor, and blood work will have to be done.

Roseola infantum


Q. What causes it?

Roseola is caused by the herpesvirus 6 and usually will affect babies 6-36 months of age.  This virus is transmitted by coughing, sneezing (travels through the air).  They will abruptly get a very high temperature (103F – 106F) and irritability.  The fever will last 72 hours and then abruptly stop and you will see a rash over their trunk.  You will see a fine, red lesions on their truck and extremities   The rash will last 1-2 days and then resolve.  The rash will not itch them or irritate them.  This virus is common in the late fall and early spring.

Q. What are the complications?

Very uncommon to have complications.  Although, they could develop febrile seizures due to the high fever.  You will want to control the fever with Tylenol and cold baths, or as directed by their doctor.  Your baby should be able to return to daycare 48 hours after fever has resolved.

This is a picture of my son’s rash when he had roseola 

Fifth Disease/Erythema infectiosum

fifth disease 2

fifth disease3

Q. What causes it?

Fifths disease is caused the parvovirus B19, usually affected preschoolers and school age children.  The virus is spread by coughing, sneezing (It travels through the air).  The disease is usually contagious before the rash appears.  You will see a fever, headache, nausea, sore muscles and jointed.  You will see the rash starting on the face with large, bright red patches on their cheeks (Slapped cheeks appearance).  Then you will see a red, itchy, lacy type rash on their arms, and over the next few days, the rash will spread over their body. The Rash should fade in 1 week, but can last 2-3 weeks.  Heat and sunlight will make the rash worse.  You will see this virus in late winter and early spring.

Q. What are the complications?

Blood disorders (anemia).  Sore joints.  Brain swelling.  Usually there are no complications in healthy children.  It is very important to avoid this disease if you’re pregnant, as it can lead to “fetal hydrops” and death of the unborn baby.    If you have been exposed and you’re pregnant, let your OB know.   Your child can return to daycare when their symptoms are gone and the rash is present (they are contagious before the rash is present).


Hand-foot-and-mouth Disease


Q. What causes it?

This is caused the coxsackie virus, a highly contagious virus.  Symptoms will start as a low-grade fever, tiredness, sore mouth, anorexia.  Then in 1-2 days, you will see ulcerations develop in their mouth.  These sores in their mouth are called herpangina.  You will also see small, reddened, flat skin lesions on their palms of their hands and soles of their feet.  These symptoms will last around 1 week.  Peak season is summer through early fall.  The virus can spread in their stool for a few months.  So, it’s very important to use good hand washing when changing diapers.  Complications are rare.  There is no vaccine for this virus.  Your child should be able to return to daycare 48 hours after the fever has resolved.



Q. What causes varicella?

Varicella is highly contagious and used by the varicella-zoster virus.  This is usually a mild, self-limiting disease in children.  You will see a fever and upper respiratory symptoms.  Symptoms will be followed by a very itchy rash.  The rash will start in the center of their trunk and spread outward.  You will see “crops” or clumps of skin lesions together.  The skin lesions will start as small, bumps that will enlarge to from vesicles (or fluid-filled bumps), which red skin around them.  Then fluid will begin to dry, and then you will see a scab over the lesion.  It will usually take 10-14 days for the lesions to all crust over.  Your child will be contagious a day before the rash appears to when all the lesions have crusted over (usually around 1 week).   

Your child may still get chickenpox even if they have their first varicella vaccination.  Usually, the rash will be less severe and you will see only 10-15 lesions on their body.  Due to the high prevalence of cases of “mild chickenpox” , a second vaccination was added at age 4.

may13 004 This is my daughter at age 3 with three varicella lesions.

Q. What are the complications?

Brain swelling (meningoencephalitis), liver swelling (hepatitis), pneumonia.  There is a vaccination for this now.  Ahtough, we all had chickenpox as children, because of the widespread use of the vaccination, your child may not be exposed, putting them at risk of getting the disease as an adult, which can be much more severe.


You will want to inform your baby’s physician if you are concerned about a viral rash.  The treatment is usually supportative treatment.  You will want to use Tylenol or Motrin (if over 6 months) to control their fevers.  NEVER give aspirin to a baby or child!!!!  Use cold baths to cool off your baby with a fever.  Make sure to dress them lightly.  If they have an itchy rash, a bath can also help to alleviate some itching.  Your doctor can also tell you if it’s safe to use an antihistamine (Benadryl is safe to give children over 6 years old.  It is not safe to give to infants, as it can decrease their respiratory drive).  Again, you will want to inform your doctor if you suspect any of these diseases, as your child may need blood work and specific treatments.