Pediatric Rashes

April 14, 2024September 18, 2018 by Rob Beatty, MD FACEP

Pediatric rashes are a common complaint, and knowing the difference between them can save time, stress, and agony. Here are a series of resources to help you differentiate between the rashes most commonly seen.

DISEASE	SEASON	PROGRESSION	MORPHOLOGY	DISTRIBUTION	ASSOCIATED FINDINGS	TREATMENT
Measles/Rubeola paramyxovirus	Winter to Spring	Incubation: 1-2 weeks Communicability: 4 days before and after the rash Rash appears 3 days after symptoms	Erythematous, confluent, maculopapular	Begins at the hairline and spreads inferiorly	Koplik Spots High Fever Cough, Coryza, and Conjunctivitis Forchheimer spots	-Infected: Supportive care -Unimmunized contacts: Measles vaccine within 72 hours of exposure or IgG within 6 days of exposure -Prevention: MMR vaccine
Scarlet Fever Streptococcus pyrogenes	Fall to Spring	Incubation: 2-4 days Hypersensitivity reaction to Group A hemolytic Strep	Generalized erythema with a sandpaper texture	Begins on the face and upper part of the trunk and spreads inferiorly	-Pastia lines -Forcheimer spots -Strawberry tongue -Sandpaper rash -Exudative pharyngitis -Abdominal Pain Rheumatic Fever	Throat Swab, oral Penicillin V, Azithromycin if allergic Can return to school 24 hours after antibiotic started
Rubella Rubivirus	Late Winter and Early Spring	Incubation: 2-3 weeks Communicability: 7 days before and after the eruptions Rash appears 1-5 days after symptoms	Rose-pink, maculopapular Rubella	Spreads inferiorly	-Lymphadenopathy -Arthralgias -Forcheimer Spots	Infected: Supportive care Prevention: MMR vaccine
Erythema Infectiousum Parvovirus B19	Winter and Spring		“Slapped cheek” appearance, lacy reticular rash Erythema Infectiosum	-Erythematous cheeks -Reticular Extremities	-Rash waxes and wanes over weeks -Arthritis -Aplastic Crisis
Roseola human herpesvirus 6 and 7	Spring	Incubation: 5-15 days Communicability: unknown Rash appears once fever subsides	Rose-pink, maculopapular	Neck and trunk	-Lymphadenopathy -Febrile seizures -Aplastic Crisis	Infected: Supportive care Prevention: No known vaccine
Varicella herpes zoster virus	Late Winter and Early Spring	Incubation: 0-3 weeks Communicability: 2 days before and 5 after the eruptions Rash appears 3-4 days after symptoms	Vesicles on an erythematous base, crusts, various stages of healing Varicella Zoster	Begins on the face and trunk and spreads centripetally	-Pruritis -Varicella-Zoster	Treatment: Supportive Care Prevention: Varicella vaccine
Hand-foot-and-mouth disease Coxsackie A virus	Late Summer or early Fall		Elliptical vesicles on an erythematous base Oral vesicles Erosions	Mouth, hands and feet	Vesicles on the hands and feet and in the mouth
Herpes simplex	Variable		-Grouped vesicles on an erythematous base (e.g. anterior oral cavity – buccal mucosa, tongue, lips, around mouth) -Herpetic whitlow, painful fingers with vesicles -Genital herpes: HSV2, shaft of penis, vagina, vulva, anus -Keratitis			Infected: Topical or Oral Acyclovir

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Pediatric Rashes

Measles/Rubeola

Scarlet Fever

Rubella

Erythema Infectiousum

Roseola

Varicella

Hand-foot-and-mouth disease

Herpes simplex

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