A. Evaluation by system:

Common Viral Rashes of Childhood

1. Fifth’s Disease or Erythema Infectiosum. Caused by Parvovirus B19.

Slapped cheek appearance; lasts for 3 weeks; mildly contagious: no isolation necessary. May have low-grade temperature, itching, systemic symptoms. Self-limited. See discussion of Parvovirus next page. Contagiousness: Risk for women in their first trimester of pregnancy.

2. Roseola Infantum. Caused by Herpesvirus-6. Starts on face and travels downward. Associated with large posterior occipital nodes. Follows 3-5 days of fever. Contagiousness: no reason to isolate child even if rash persists several days.

3. Enteroviral Illnesses: Seen mostly in the summer.

A. ECHO virus. Like roseola, rash can appear after several days of fever. Rash is macular, can be generalized, can involve hands and feet. Rash can be petechial with normal platelet counts. Self-limited illness usually, but meningitis is not uncommon; other systemic illnesses reported such as liver disease, lung disease, etc. Contagiousness: If fever present, isolate child until fever is gone.

B. Coxsackie virus--- divided into Coxsackie A and B. Coxsackie A: herpangina (different from herpes): Involves soft palate with vesicles; usually associated with fever, generalized viral symptoms; also causes the common form of hand, foot, and mouth disease, characterized by vesicles in those three areas. Acyclovir has been used in Rx.
Coxsackie B: produces pleurodynia, myocarditis; B3, B4 are associated with diabetes mellitus; some have correlated infection with Coxsackie B with chronic fatigue syndrome as well. Contagiousness: If fever is present, child should be isolated until fever is gone.

4. Varicella: Vaccine now available- will probably see less and less of this disease. Rash starts on trunk with “dew drop on a rose petal” appearance, then spreads to the rest of the body. Incubation period: 14-17 days; major problems are itching and fever, but sore throat, systemic illness can develop with varicella. Acyclovir not indicated in routine cases. Contagiousness: For 8-10 days.

5. Herpes Zoster: Usually confined to one specific dermatome. Still an uncommon problem in children less than 10 years of age. Usually child has a past history of having had varicella. Not clear on what effect vaccine will have on the frequency of this condition.
Ramsey-Hunt Syndrome: Infection of the 7th nerve with vesicles in ear canal. Contagiousness: Drainage precautions of the lesions only; otherwise not isolated.

6. Infectious Mono: Rash is seen in 3-15% of children with this condition. However, 80% of children with mono treated with Amoxicillin will get this rash. Rash is maculopapular, generalized. If illness is associated with thrombocytopenia, may see petechiae and purpura as well.

7. Herpes Simplex: Herpesvirus Hominis; HSV-1: oral; HSV-2: genital. Skin: vesicles have an erythematous base. They rupture, scab, and heal in 7-10 days, but are often associated with secondary bacterial impetigo. Can be treated topically with acyclovir. Gingivostomatitis: affects 1-3 year olds mostly; often associated with high fevers, drooling, ulcerated sores in the mouth, and even dehydration. Meds (acyclovir) have been thought not to be helpful, but one recent abstract suggests it might shorten the course of the illness. Also can complicate eczema (eczema herpeticum), and be difficult to treat. Contagiousness: Isolate as long as there is fever.

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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