Rashes are a top concern for parents, and it’s no surprise why. They can be caused by a variety of things – bacterial or viral infections, allergic reactions, eczema, heat, insect bites, or even irritation with no clear explanation (yes, sometimes we don’t know why!). Spotting a rash can feel especially alarming when your child is already feeling unwell.
Viral rashes, or viral exanthems, are rashes caused by viral infections and often come with other symptoms like fever, cough, or runny nose. These rashes can look very different – spots, bumps, widespread red patches – but they usually resolve on their own. Knowing what to look for and how to manage symptoms can provide valuable reassurance, especially when it comes to the four most common viral rashes in children: Fifth Disease, Sixth Disease (Roseola), Measles, and Chickenpox.
For an in-depth look, check out the PedsDocTalk YouTube videos:
Pediatrician Explains Viral Rashes and Fifth Disease and Sixth Disease (Roseola)
Understanding Viral Rashes: Causes, Symptoms, and Treatment Part 2
What are viral rashes?
Viral rashes, also known as viral exanthems, are rashes caused by the body’s reaction to a viral infection. When your child’s immune system fights off a virus, their skin sometimes responds by developing a rash.
These rashes can vary greatly in appearance. They might look like small spots, raised bumps, or widespread red patches. Some are localized to one area of the body, while others can spread. Often, these rashes appear alongside other viral symptoms like fever, cough, or fatigue.
Many viral exanthems are self-limiting, which means they go away on their own as the viral infection runs its course. Treatment typically focuses on managing symptoms, like relieving fever or soothing itching.
Fifth Disease (Slapped Cheek Syndrome)
Fifth Disease, caused by Parvovirus B19, is a common viral rash known for its distinctive “slapped cheek” appearance. This rash often affects children and gets its name from being the fifth viral exanthem described in medical history.
The rash is usually accompanied by mild symptoms like fever, runny nose, fatigue, or headache. After the cheek rash appears, a lacy, pink rash may spread to the arms, legs, and torso. Interestingly, the rash can fade and appear in response to heat, sunlight, or physical activity. Thankfully, it’s generally not painful or itchy for most children.
Fifth Disease spreads through respiratory droplets, making it highly contagious before the rash appears. However, once the rash is visible, the virus is no longer contagious. This timing can be reassuring for parents worried about spreading the illness to others in the household or at school.
While Fifth Disease is generally mild, there are situations where extra caution is needed. Pregnant individuals exposed to Parvovirus B19 should consult their healthcare provider, as the virus can rarely cause complications like hydrops fetalis. Children with weakened immune systems or blood disorders, such as sickle cell disease, are also at risk for more severe complications, including a temporary decrease in red blood cell production.
For more images of the rash and treatment tips, watch this PedsDocTalk YouTube video.
Sixth Disease (Roseola)
Sixth disease, known as Roseola, is a common viral illness in children, typically between 6 months and 2 years old. It’s caused by the Human Herpesvirus 6 (HHV-6) and, less frequently, by Human Herpesvirus 7 (HHV-7). Despite its name, this virus is not related to the herpes viruses associated with cold sores or genital herpes, which often confuses parents.
The hallmark of Roseola is a sudden high fever, often over 102 degrees Fahrenheit and lasting 3-5 days. During this time, children may appear irritable or tired, but many remain surprisingly playful despite the fever. Once the fever abruptly subsides, a pinkish-red rash emerges. This rash typically starts on the chest and spreads to the arms, neck, and sometimes the face. The spots may be flat or slightly raised and generally fade within a few days without causing discomfort.
Roseola spreads through respiratory droplets and saliva, meaning it can be passed along through coughing, sneezing, or sharing cups and utensils. Children are most contagious during the fever stage, but once the rash appears, they are no longer contagious.
One potential complication of Roseola is febrile seizures, which occur in about 10-15% of children with a high fever. These seizures, while alarming, are usually harmless and resolve quickly. For more information on febrile seizures, watch this PedsDocTalk YouTube video.
Roseola is often mistaken for more serious infections during the fever stage, leading to unnecessary tests or treatments. However, if your child is otherwise hydrated, consolable, and breathing comfortably, close monitoring is often the best approach.
For a closer look at Roseola and tips for managing the symptoms, check out this PedsDocTalk YouTube video.
Measles
Measles is a highly contagious viral illness that, while rare thanks to widespread vaccination, still poses a serious risk in communities with lower vaccination rates or international travel exposure. This virus can cause significant complications, making awareness and prevention very important.
The symptoms of measles include fever, often very high, along with a classic triad: cough, coryza (runny nose), and conjunctivitis (red eyes). As the illness progresses, small white spots known as Koplik spots may appear inside the mouth, followed by a rash that starts on the face and spreads downward to the rest of the body.
Measles spreads through the air via respiratory droplets, making it highly contagious. A person with measles is infectious for about four days before and after the rash appears. Unvaccinated individuals exposed to the virus have a high likelihood of contracting it, which is why the MMR vaccine is so important.
For most children, measles resolves in 7-10 days as their immune system fights off the virus. It’s important to monitor them closely because it can lead to serious complications such as ear infections, pneumonia, and, in rare cases, encephalitis (swelling of the brain). These potential complications highlight the seriousness of this disease.
If your child has been exposed to measles, it’s essential to contact your child’s pediatrician immediately. Early intervention can reduce the severity of the illness. Be sure to call ahead before visiting the doctor to avoid exposing others.
For additional guidance on identifying and managing measles, take a look at this PedsDocTalk YouTube video.
Chickenpox (Varicella)
Chickenpox, caused by the varicella-zoster virus, is a contagious viral illness that most commonly affects children. Thanks to the introduction of the chickenpox vaccine, cases have significantly deceased, but it’s still important to recognize the symptoms and understand how to manage them.
The first sign of chickenpox is often a fever, which may start a day or two before the characteristic rash appears. The rash begins as small, red spots on the face, chest, and back, which then develop into fluid-filled blisters. These blisters are intensely itchy and eventually burst, leaving scabs that heal over time. New spots may continue to form for several days, meaning you’ll often see a mix of spots, blisters, and scabs at the same time.
Chickenpox spreads easily through respiratory droplets and direct contact with the blisters. A child with chickenpox is contagious from one to two days before the rash appears until all blisters have scabbed over, which typically takes about 7-10 days.
While chickenpox is usually mild, it can lead to serious complications in certain cases. Infants, adults, and individuals with weakened immune systems are at higher risk for complications such as bacterial skin infections, pneumonia, encephalitis (swelling of the brain), and sepsis (infection of the blood). This is why vaccination is so important – it protects your child from severe illness and helps reduce the number of chickenpox cases in the community.
For more tips and visuals to recognize chickenpox, watch the PedsDocTalk YouTube video.
When to see a doctor?
Certain symptoms or circumstances during an illness can indicate the need for medical attention, espeically when a rash is involved. Contact your child’s pediatrician if:
- Fever persists: A fever lasting more than 5 days or recurring after the rash appears.
- Your child appears very unwell: Signs like dehydration, difficulty breathing, or extreme irritability are reasons to seek medical care.
- The rash looks unusual: If the rash is spreading rapidly, appears infected, or is causing significant discomfort, it’s best to get it checked.
- There’s a known health risk: Children with weakened immune systems, chronic conditions, or specific exposures (like measles or Fifth Disease during pregnancy) may need extra care.
- A febrile seizure occurs: Although often harmless, febrile seizures can be frightening. Reach out to your child’s pediatrician for guidance and reassurance.
This list doesn’t cover every situation, so always trust your instincts as a parent. If your child seems unusually unwell or their symptoms are worsening, don’t hesitate to reach out to their doctor.
For a more detailed breakdown of these rashes and what to watch for, check out these two PedsDocTalk YouTube videos:
Pediatrician Explains Viral Rashes and Fifth Disease and Sixth Disease (Roseola)
Understanding Viral Rashes: Causes, Symptoms, and Treatment Part 2
