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Viral Exanthems in Children

What Is a Viral Exanthem?

A viral exanthem is a skin rash that occurs in response to a viral infection. These rashes typically affect large areas of the body and often appear alongside fever or other signs of illness.

Viral rashes are especially common in children due to their developing immune systems and frequent exposure in schools or daycare. While most are mild and self-limiting, it’s important to distinguish typical viral rashes from those indicating more serious conditions.

Common Viral Exanthems in Children

Roseola (Sixth Disease) – HHV-6

  • Age: 6 months to 2 years
  • Symptoms: High fever lasting 3–4 days, followed by a pink rash on the torso as the fever disappears
  • Rash Duration: Lasts 1–3 days, not itchy
  • Contagiousness: While febrile

Fifth Disease – Parvovirus B19

  • Symptoms: Mild fever, fatigue, red “slapped cheek” rash, followed by a lace-like body rash
  • Contagiousness: Before rash appears, not afterward
  • Risk Groups: Pregnant women (fetal complications), children with anemia

Measles – Measles Virus

  • Symptoms: High fever, cough, runny nose, red eyes, Koplik spots in mouth, and a full-body red rash starting behind the ears
  • Contagiousness: 4 days before and after rash onset
  • Prevention: MMR vaccine

Rubella (German Measles) – Rubella Virus

  • Symptoms: Low-grade fever, swollen neck lymph nodes, pink rash starting on the face
  • Risk: Harmful during pregnancy (congenital rubella syndrome)
  • Prevention: MMR vaccine

Chickenpox – Varicella-Zoster Virus

  • Symptoms: Fever, fatigue, itchy red spots that turn into blisters and scabs
  • Contagiousness: From 1–2 days before rash until all spots have crusted
  • Prevention: Varicella vaccine

Enterovirus Rashes (e.g., Hand-Foot-and-Mouth)

  • Symptoms: Blisters on hands, feet, and inside the mouth, sometimes buttocks
  • Contagiousness: High during early illness
  • Seasonality: More common in summer/fall

Common Features of Viral Rashes

Feature

Viral Exanthems

Fever

Often present

Rash onset

During or after fever

Rash location

Face, trunk, limbs

Rash color & shape

Pink/red, flat or raised

Itching

Variable (e.g., itchy in chickenpox)

Duration

Usually 3–7 days

Systemic symptoms

Often mild unless complicated

Diagnosis

Diagnosis is typically clinical—based on history and examination.

  • Key clues: Fever timing, rash pattern, exposure history

  • Lab tests (if needed):

    • CBC, CRP

    • Viral antibody panels (measles, rubella, varicella)

    • PCR (for confirmation in complex cases)

In uncomplicated cases, no specific tests are needed.

Treatment and Home Care

There is usually no specific antiviral treatment—management is supportive.

General Recommendations:

  • Fever: Paracetamol (acetaminophen), not aspirin
  • Hydration: Offer fluids frequently
  • Itching: Antihistamines, cool baths, calamine lotion
  • Skin care:
     
    • Don’t pop blisters (e.g., chickenpox)
       
    • Keep nails short to avoid scratching
       
  • Isolation: Keep child at home during contagious period
  • Clothing: Light, breathable cotton garments

When to See a Doctor

Contact a healthcare provider if:

  • Fever persists >3 days or is above 39°C (102.2°F)
  • Rash looks infected (pus, swelling, increasing redness)
  • Child appears very sleepy, irritable, or confused
  • Rash is purple, spreading rapidly, or painful
  • Child is under 3 months old or immunocompromised
  • Child has breathing difficulty or seizures

Care with Dr. Ekin Pasinlioğlu

  • Clinical diagnosis of viral rashes
  • Differentiation from bacterial or allergic skin conditions
  • Monitoring for complications
  • Counseling on isolation, hygiene, and vaccination
  • Coordination with daycare/school during outbreaks
  • Education for parents on when to return to normal activities