Rash Illnesses: Additional Information

  • Measles - Prodrome begins with malaise, cough, coryza, or conjunctivitis, lasting 2 to 4 days and fever of 102-104° F. Koplik spots may be present 1-2 days prior to rash until 1-2 days after rash. Reddish brown maculopapular rash appears on day 3-4, starting at the head and hairline progressing downward over a period of 3 days, reaching the feet. Lesions on the trunk become confluent when the extremities become involved. Rash lasts 5-6 days, and clears in the same order as it appears. Illness lasts 7-10 days, and is moderately severe.
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  • Chickenpox (varicella)-Begins with low-grade fever (100-102° F) and malaise for 2-3 days during the evolution of the skin eruption. Lesions rapidly progress from macule to papule to vesicle to crust. Lesions commonly occur in successive crops, with several stages of maturity present at the same time. The rash is generally first seen on the face or trunk, and progresses to involve the extremities. The vesicular stage itches and has been described as a "dew drop on a rose petal." Height of fever parallels extent of rash (i.e., higher fever usually means more rash). The same virus (Herpes zoster, not simplex) causes "shingles" and disseminated zoster. The latter illnesses are more commonly observed in children with underlying chronic conditions.
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  • Rubella - Young children have no prodrome. Adolescents and adults may have 1-5 days of low-grade fever, headache, malaise, mild conjunctivitis, coryza, sore throat, cough, and lymphadenopathy. Post-auricular and posterior cervical nodes are often enlarged, nontender, and generally last several weeks. Adolescents and adults may have joint pain or frank arthritis. Pink maculopapular rash begins on the face and neck, and moves downward to the trunk and extremities within 24-48 hours. The lesions are usually discrete rather than confluent, and turn into an erythematous blush that disappears without desquamation by the third to fourth day. The rash is occasionally pruritic or may be absent. Illness is generally mild and 30-50 percent of cases may be subclinical or non-apparent.
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  • Scarlet Fever - Illness begins abruptly with fever of 102-104° F, sore throat, and vomiting, although the latter two symptoms may be absent. Initially, tongue is covered with a thick white "fur" which peels to develop into the typical strawberry tongue. The rash is an erythematous punctiform eruption which blanches on pressure and is often felt (like sandpaper) better than seen. It begins on the neck and upper trunk 6-48 hours after the fever, and becomes generalized within 24 hours of onset. The lesions are most intense and prominent in the neck, axillary, inguinal, and popliteal skin folds. The forehead and cheeks are smooth, red, and flushed, but the area around the mouth is pale (circumoral pallor). Rash and illness lasts 5-9 days, and is followed by desquamation that generally involves the hands and feet. The illness may be mild or moderately severe. Antibiotic therapy is required.
  • Roseola (Exanthem Subitum)- Illness characterized by fever of 103-105° F, lasting for 3-5 days. Cervical and posterior auricular adenopathy is often noted. Within 48 hours after the fever falls, a discrete rose-red maculopapular rash appears first on the trunk or chest and spreads to involve the face and extremities. The rash may last for a few hours to a few days. Despite the high fever, illness is generally mild and infants do not appear very ill. Illness usually affects children under four years of age.
  • Fifth Disease (erythema infectiosum) - Generally, the patient is afebrile and asymptomatic. Lymphadenopathy and low-grade fever may be present, but are most frequently absent. The rash evolves in three stages, beginning with the appearance of erythema of the cheeks ("slapped cheeks"). The cheeks may be hot, but are not painful, and circumoral pallor may also be present. Then, a secondary generalized discrete maculopapular rash that may be pruritic appears. The rash often takes on a characteristic "lace-like" or "chicken-wire" appearance, and usually disappears within a week. Finally, there is a variable period lasting for weeks in which the eruption recurs after stimulation of the skin with sunlight, hot baths, exercise, or emotional stress.
  • Rocky Mountain Spotted Fever - Sudden onset of headache, chills, fever in excess of 102° F, significant malaise, and deep muscle pain (especially, the back and legs). Additional symptoms may include nausea, vomiting, upper abdominal pain, photophobia, arthralgias, and conjunctival injection. The rash appears between the second and sixth day of illness (average four days) as an erythematous macular eruption involving the wrists, ankles, and palms, soles and forearms that rapidly become maculopapular in character and spreads to involve the proximal extremities, trunk and face. After 3-4 days, the lesions become petechial, and in more severe cases, may coalesce to form ecchymoses. More severe cases are characterized by profound alterations in the neurologic, hematologic, cardiovascular, and metabolic status of the patient. In the U.S., the fatality rate is about 15-20 percent in the absence of specific therapy.
  • Enteroviral infections -the echoviruses can cause a wide variety of clinical syndromes, including fever with rash, sore throat, aseptic meningitis, diarrhea and vomiting, mild respiratory illness, or rarely encephalitis. The rash of echovirus and coxsackie virus infections is rubella-like in appearance. The lesions are usually maculopapular, discrete, nonpruritic, and generalized. The rash usually appears during the period of fever, spreads from the face and neck to the trunk within 6-12 hours, and lasts from 1-7 days.