Viral Exanthems (Rashes)

The most common childhood viral exanthems include the following:

  • Measles (rubeola)
  • Rubella (german measles)
  • Varicella (or chickenpox)
  • Fifth disease
  • Roseola

Immunizations have decreased the number of cases of measles, mumps, rubella, and chickenpox, but all viral skin infections require clinical care by a physician or other healthcare professional. Each of the viral exanthems listed here have a distinct pattern, which can aid in the diagnosis.

Measles (or Rubeola)

What is measles (rubeola)?

Rubeola, also called 10-day measles, red measles, or measles, is a very contagious viral illness that results in a distinct rash. It is spread from one child to another through direct contact with discharge from the nose and throat, or via air-borne droplets from an infected child. Measles is a highly contagious disease that usually consists of a rash, fever, and cough.

What causes measles?

The measles virus, which causes the disease, is classified as a Morbillivirus. It is mostly seen in the winter and spring, but measles is preventable with proper immunization.

The measles vaccine is usually given in combination with the mumps and rubella vaccine. It is called the MMR and is usually given when the child is 12 to 15 months old and then again between 4 and 6 years of age.

What are the symptoms of measles?

After exposure to the disease, it can take between 8 to 12 days for a child to develop symptoms of rubeola. Children are contagious 1 to 2 days before the onset of symptoms and 3 to 5 days after the rash develops. This means that children can be contagious before they even know they have measles.

During the early stages of measles (which lasts between 1 to 4 days), symptoms usually resemble those of an upper respiratory infection. Each child may experience symptoms differently, however. Common symptoms may include:

  • Hacking cough
  • Redness and irritation of the eyes
  • Fever
  • Small red spots with white centers on the inside of the cheek (these usually occur two days before the rash on the skin appears)
  • A deep, red, flat rash that starts on the face and spreads down to the trunk, arms, and legs. The rash starts as small distinct lesions, which then combines to form one big rash. After 3 to 4 days, the rash will begin to clear, leaving a brownish discoloration and skin peeling

The most serious complications from measles include the following:

  • Ear infections
  • Pneumonia
  • Croup
  • Inflammation of the brain

The symptoms of rubeola may resemble other skin conditions or medical problems. Always consult a physician for a diagnosis.

How is rubeola diagnosed?

Measles is usually diagnosed based on a complete medical history and physical examination of the child. The lesions of rubeola are unique, and usually allow for a diagnosis simply on physical examination. In addition, a physician may order blood or urine tests to confirm the diagnosis.

The most serious complications from measles include the following:

  • Ear infections
  • Pneumonia
  • Croup
  • Inflammation of the brain

The symptoms of rubeola may resemble other skin conditions or medical problems. Always consult a physician for a diagnosis.

What is the treatment for rubeola?

Specific treatment for measles will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference 

Aspirin and the Risk of Reye Syndrome in Children

Do not give aspirin to a child without first contacting the child's physician. Aspirin has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

Because measles is caused by a virus, there is no cure for rubeola. The goal of treatment is to help prevent the disease, or decrease the severity of the symptoms.

  • Increased fluid intake
  • Acetaminophen for fever (DO NOT GIVE ASPIRIN)

Prevention of Rubeola

Since the widespread use of the rubeola (measles) vaccine, the incidence of measles has decreased by 99 percent. About 5 percent of measles are due to vaccine failure.

If the child was exposed and has not been immunized, the physician can give the vaccine to the child within 72 hours to help prevent the disease.

Other ways to prevent the spread of rubeola include:

  • Children should not attend school or daycare for 4 days after the rash appears
  • Confirm that the child's contacts have been properly immunized

Rubella (German Measles)

What is rubella (German measles)?

Rubella is a viral illness that causes a rash on the skin. It is spread from one child to another through direct contact with discharge from the nose and throat.

Warning

Pregnant women who have been exposed to rubella need to seek medical attention immediately.

Infants and children who develop the disease usually only have a mild case of the rash and side effects. However, children who contract rubella from their mother while she is pregnant can have severe birth defects and consequences. It is also very dangerous for pregnant women to come in contact with someone who has rubella, because it can cause a miscarriage.

What causes rubella?

Rubella is caused by a virus called a Rubivirus. It can be spread from a pregnant mother to the unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization.

The rubella vaccine is usually given in combination with the measles and mumps vaccine. It is called the MMR vaccine and is usually administered when the child is 12 to 15 months old, and then again between 4 and 6 years of age.

What are the symptoms of rubella?

The disease itself does not have any long-term consequences. The biggest concern is to prevent an infected child from infecting a pregnant woman. Take note of the following facts:

  • It can take between 14 to 21 days for a child to develop signs of rubella after coming in contact with the disease
  • Children are most contagious when the rash is erupting
  • A child can be contagious beginning 7 days before the onset of the rash and 14 days after the rash has appeared
  • Children may be contagious before they even know they have rubella.

The following are the most common symptoms of rubella. However, each child may experience symptoms differently.

Childhood rubella

  • Rubella may begin with a period of not feeling well, a low-grade fever, and diarrhea. This may last one to five days.
  • The rash then appears as a pink rash with areas of small, raised lesions.
  • The rash begins on the face and then spreads down to the trunk, arms, and legs.
  • The rash on the face usually improves as the rash spreads to the arms and legs.
  • The rash usually fades by the third to fifth day.
  • Lymph nodes in the neck may also become enlarged.
  • Older children and adolescents may develop some soreness and inflammation in their joints.

Congenital rubella

Rubella that is present at birth where the child contracted it from the mother while in utero, can result in many problems, including the following:

  • Cataracts in the eyes
  • Heart problems
  • Mental retardation
  • Growth retardation
  • Enlarged liver and spleen
  • Skin lesions
  • Bleeding problems

The symptoms of rubella may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is rubella diagnosed?

Rubella is usually diagnosed based on a medical history and physical examination of the child. The lesions of rubella are unique, and usually the diagnosis can be made on physical examination. In addition, the child's physician may order blood or urine tests to confirm the diagnosis.

What is the treatment for rubella?

Specific treatment for rubella will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for rubella. The goal of treatment for rubella is to help prevent the disease, or decrease the severity of the symptoms. Treatment may include increased fluid intake or rest.

Prevention of Rubella

Since the introduction of rubella vaccine, the incidence of rubella has decreased by more than 99 percent. Most cases today occur in adults who have not been vaccinated.

Other ways to prevent the spread of rubella:

  • Children should not attend school for 7 days after the onset of the rash.
  • Children who are born with rubella are considered contagious for the first year of life.
  • Check that a child's contacts have been properly immunized.

Roseola

What is roseola?

Roseola is a contagious viral illness that is marked by a high fever and a rash that develops as the fever decreases.

What causes roseola?

Roseola is likely caused by more than one virus, but the most common cause is the human herpesvirus 6 (HHV-6). Roseola occurs mostly in children under the age of 3, and occurs more often in the spring and fall.

What are the symptoms of roseola?

It can take between 5 and 15 days for a child to develop symptoms of roseola after being exposed to the disease. Children are most contagious during the period of high fever, before the rash occurs.

The following are the most common symptoms of roseola. However, each child may experience symptoms differently.

  • High fever that starts abruptly
  • Fever (may last three to four days)
  • Irritability
  • Swelling of the eyelids
  • Rash (as the fever decreases, a pink rash, with either flat or raised lesions, starts to appear on the trunk and then spreads to the face, arms, and legs.)

What are the complications of roseola?

The most serious complication of roseola is febrile seizures. As the child's temperature rises, there is a chance that the child will have a seizure.

The symptoms of roseola may resemble other skin conditions or medical problems. Always consult a physician for the proper diagnosis.

How is roseola diagnosed?

Roseola is usually diagnosed based on a medical history and physical examination of your child. The rash of roseola that follows a high fever is unique, and often the diagnosis is made simply on physical examination.

Aspirin and the Risk of Reye Syndrome in Children

Do not give aspirin to a child without first contacting the child's physician. Aspirin has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

What is the treatment for roseola?

The specific treatment for roseola will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for roseola. The goal of treatment for roseola is to help decrease the severity of the symptoms. Treatment may include increased fluid intake or acetaminophen for fever (DO NOT GIVE ASPIRIN).

Fifth Disease

What is fifth disease?

Fifth disease is a moderately contagious viral illness that causes a rash on the skin, but no fever, as with other viral illnesses. It is spread from one child to another through direct contact with discharge from the nose and throat and can also be spread through contact with infected blood.

What causes fifth disease?

Fifth disease is caused by the human parvovirus. It is most prevalent in the winter and spring and is usually seen in children ages 5 to 14. Outbreaks of the disease frequently occur in school settings.

What are the symptoms of fifth disease?

It can take between 4 to 14 days for a child to develop symptoms of fifth disease after being exposed to the disease. Children are most contagious before the rash occurs, meaning they are often contagious before they even know they have the disease. In addition, about 20 percent of people with fifth disease do not have symptoms but can still spread the disease.

The following are the most common symptoms of fifth disease. However, each child may experience symptoms differently.

  • There may be an early phase with the following symptoms, although this is not very common. If this happens, symptoms may include the following:
    • Fever
    • Headache
    • Red eyes
    • Sore throat
  • The rash is usually the primary symptom of fifth disease. The rash:
    • Starts on the cheeks and is bright red. The rash looks like slapped cheeks.
    • Spreads to the trunk, arms, and legs, and lasts two to four days.
    • May continue to reappear if the child is exposed to sunlight, very hot or cold temperature, or trauma to the skin. This may continue for several days.

Warning

Pregnant women who have been exposed to fifth disease need to seek immediate medical attention.

Fifth disease is usually a mild illness. However, parvovirus B19 infection can cause an acute severe anemia in persons with sickle-cell disease or immune deficiencies. Also, there is a small risk of fetal death if fifth disease is acquired during pregnancy.

The symptoms of fifth disease may resemble other conditions or medical problems, so consult a physician for proper diagnosis.

How is fifth disease diagnosed?

Fifth disease is usually diagnosed based on a complete medical history and physical examination of the child. The rash and progression of fifth disease is unique, and usually allows for a diagnosis simply on physical examination. The physician may also order blood tests to aid in the diagnosis.

Aspirin and the Risk of Reye Syndrome in Children

Do not give aspirin to a child without first contacting the child's physician. Aspirin has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

What is the treatment for fifth disease?

The specific treatment for fifth disease will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Since it is a viral infection, there is no cure for fifth disease. The goal of treatment for fifth disease is to help decrease the severity of the symptoms. Treatment may include increased fluid intake or acetaminophen for fever (DO NOT GIVE ASPIRIN).

Chickenpox

What is chickenpox?

Chickenpox is a highly infectious disease, usually associated with childhood. By adulthood, more than 95 percent of Americans have had chickenpox.

The disease is caused by the varicella-zoster virus (VZV), a form of the herpes virus. Transmission occurs from person-to-person by direct contact or through the air.

Chickenpox most commonly occurs in children between the ages of 5 and 9. In the US, in areas with a large number of children in daycare settings, chicken pox in children between the ages of 1 and 4 is common.

What is the chickenpox vaccine?

Since 1995, a chickenpox vaccine has been available for children 12 months of age and older. Adolescents and adults who have never had chickenpox can also get the vaccine. The vaccine has proven very effective in preventing severe chickenpox.

The Center for Disease Control & Prevention’s Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend that all children be vaccinated with the chickenpox vaccine between 12 and 18 months of age.

A booster vaccination is recommended again between 11 and 12 years of age. Many schools now require vaccination prior to entry into preschool or public schools.

What are the symptoms of chickenpox?

Symptoms are usually mild among children, but may be life threatening to infants, adults, and people with impaired immune systems.

The following are the most common symptoms of chickenpox. However, each child may experience symptoms differently. Symptoms may include:

  • Fatigue and irritability one to two days before the rash begins
  • Itchy rash on the trunk, face, under the armpits, on the upper arms and legs, and inside the mouth
  • Fever
  • Feeling ill
  • Decreased appetite
  • Muscle and/or joint pain
  • Cough or runny nose

The symptoms of chickenpox may resemble other skin problems or medical conditions. Always consult a physician for a diagnosis.

How is chickenpox spread?

Once infected, chickenpox may take 10 to 21 days to develop. Chickenpox is contagious for one to two days before the appearance of the rash and until the blisters have dried and become scabs, which usually happens within 4 to 5 days of the onset of the rash.

Children should stay home and away from other children until all of the blisters have scabbed over. Family members who have never had chickenpox have a 90 percent chance of becoming infected when another family member in the household is infected.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed based on a complete medical history and physical examination of the child. The rash of chickenpox is unique, and usually a diagnosis can be made from a physical examination.

What is the treatment for chickenpox?

The specific treatment for chickenpox will be determined based on:

  • The child's age, overall health, and medical history extent of the condition
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition child or parent’s opinion or preference

Aspirin and the Risk of Reye Syndrome in Children

Do not give aspirin to a child without first contacting the child's physician. Aspirin has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

The treatment for chickenpox may include:

  • Acetaminophen for fever (DO NOT GIVE ASPIRIN)
  • Antibiotics for treating bacterial infections
  • Calamine lotion (to relieve itching)
  • Antiviral drugs (for severe cases)
  • Rest
  • Increased fluid intake (to prevent dehydration)
  • Cool baths with baking soda or Aveeno (to relieve itching)

Children should not scratch the blisters, as this can lead to secondary bacterial infections. Keep the child's fingernails short to decrease the likelihood of scratching.

What is immunity from chickenpox?

Most individuals who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains dormant in nerve tissue and may reactivate, resulting in herpes zoster (shingles) later in life.

Occasionally a secondary case of chickenpox does occur. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

What complications are commonly associated with chickenpox?

Complications can occur from chickenpox. Those most susceptible to severe cases of chickenpox are infants, adults, pregnant women (unborn babies may be infected if the mother has not had chickenpox prior to pregnancy), and people with impaired immune systems. Complications may include:

  • Secondary bacterial infections
  • Pneumonia
  • Encephalitis (inflammation of the brain)
  • Cerebellar ataxia (defective muscular coordination)
  • Transverse myelitis (inflammation along the spinal cord)
  • Reye syndrome (a serious condition which may affect all major systems or organs)
  • Death
Children's Team

Children's Team

Providers

Departments

Departments

Dermatology

The Division of Dermatology at Children's National Health System continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair, and nails.

Invest in future cures for some of life's most devastating diseases

See other ways to give

Keep in touch with Children's National by signing up for our newsletters.

Sign up now