Viral Rash In Children: Types, Pictures, Treatment And Prevention

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Viral rash in children, also known as viral exanthem, occurs when the skin is inflamed due to a viral infection (1). The rash may be in one spot (localized) or on the entire body (widespread), appearing as bumps, reddish-pink blotches, pimples, or blisters. In rare cases, the rash may cause itching, stinging, or a burning sensation.

Depending on the kind of viral infection that caused it, a viral rash may resolve on its own or require treatment. Usually, the rash takes a few days to around two weeks to resolve once the treatment is begun. Parents should consult a doctor if their children show symptoms of fever and cough along with the rash.

Read this post to understand the different types of viral rash in children and their treatment and effective prevention.

Types Of Viral Rash In Children

Viral rash in children can be of different types. The type depends on the virus responsible for the infection (1). Often, children get additional symptoms, such as fever and vomiting, along with the rash.

Here are some of the common viral infections that occur in children and cause a viral rash.

1. Measles (Rubeola)

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Measles, also known as rubeola or 10-day measles, is a highly contagious viral infection caused by the measles virus belonging to the genus Morbillivirus (2). The infection spreads from one child to another through direct contact with the infected child’s body fluids, such as nasal and throat discharge, or via airborne droplets when an infected child coughs or sneezes without covering their mouth.

Infographic: Common Viral Infections That Lead To Rashes In Children

Illustration: Momjunction Design Team

The skin rash caused by the infection usually appears two weeks after the child is exposed to the virus. The rash appears as a deep, red, flat rash and generally spreads from the head or neck to the limbs and lower extremities (cephalo-caudal distribution). The rash begins to clear three to four days after its appearance. Some of the other symptoms and signs that often accompany measles rash include (1).

• Hacking cough
• Fever
• Redness and irritation of the eyes
• Vomiting
• Diarrhea

Since rubeola is a viral infection, the treatment focuses on symptomatic relief by decreasing the severity of the infection. It is best prevented through vaccination.

Quick fact

A child infected with measles virus is said to be contagious from four days before to four days after the rash appears (2).

2. Roseola Infantum

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Roseola Infantum is a common and contagious viral infection caused by human herpesvirus 6 (HHV-6), and less frequently by human herpesvirus 7 (HHV-7). It mostly occurs in children under three years of age (3). The illness begins with a high fever that usually lasts for two to three days, followed by a rash.

As the fever subsides, pinkish-red rashes with flat or raised patches or bumps appear on the abdominal region and spread to the face and limbs. A study by the University of Rochester School of Medicine and Dentistry indicates that 30% of children with roseola infantum have an onset rate of a rash following up to a day of persistent fever. The rash isn’t itchy and lessens or disappears after two to three days. Some other symptoms of roseola include (4).

• Loss of appetite
• Cold-like symptoms such as a sore throat, runny nose, and cough
• Swollen glands in the neck
• Swollen eyelids

The infection is self-limiting, and the treatment aims at providing symptomatic relief, such as the prescription of acetaminophen for fever management. In addition, rest and proper fluid intake help recovery. Children are most contagious when they have a high fever, and once the fever subsides, the child is no longer contagious even if the rash is present.

3. Chickenpox (Varicella)

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Chickenpox is a highly contagious viral infection that commonly affects children between five and nine years of age (1) (5).

The disease can cause a rash that starts as a small red bump and gradually changes to blisters or spots, and then to open sores, and finally, scabs. The rash appears on the chest, back, and face and spreads to other body parts, including the genitals.

Since the blisters are itchy, children tend to scratch them, which can cause scars after healing. Also, it may raise the risk of skin infections, such as cellulitis. Some other symptoms that a child with chickenpox may manifest are:

• Fatigue and irritability (one to two days before the rash appears)
• Fever and malaise
• Reduced appetite
• Joint or muscle pain
• Cold-like symptoms

Chickenpox may last for up to a week, during which crops of new chickenpox lesions keep appearing. Vaccination is the best way to prevent its occurrence.

Quick tip

Apply calamine lotion on the rashes or give your child cool baths with baking soda to relieve itching (1).

4. Hand, foot, and mouth disease (HFMD)

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Hand-foot-mouth disease is a highly contagious infection caused by coxsackieviruses from the enterovirus family (6).

It is a common childhood disease affecting children under five years of age who go to school and daycare facilities. However, it can occur at any age and spread from one person to another through respiratory droplets, contaminated surfaces, and person-to-person contact.

Its common symptoms include fever, mouth sores, sore throat, and rash on the hand, mouth, and face. The rash looks like flat, red spots, sometimes with blisters filled with fluid that turns into scabs once the rash begins healing. Most children have mild symptoms for up to a week to ten days.

Since the disease has no cure, the treatment focuses on symptomatic relief. Further, there’s no vaccine for HFMD. Thus, maintaining good hygiene is the only preventive measure.

5. Fifth disease

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Fifth disease (erythema infectiosum) is a common skin condition in children that is caused by parvovirus B19 (7). Some children with fifth disease can stay asymptomatic, while others may have a mild fever, headache, and runny nose, along with an itchy rash appearing first on the face and then the body. The characteristic red rash that appears on the cheek, known as slapped cheek rash, is the most recognized feature of fifth disease.

Generally, the rash subsides in seven to ten days, but it can recur for several weeks. When the rash finally starts to disappear, it may look lacy. The condition is often self-limiting and requires medical intervention only to relieve problematic symptoms, such as fever, joint pain, swelling, and itching.

However, children with weakened immunity and those with blood disorders are at risk of adverse complications. Hence, preventing the disease by following optimum hygiene standards is vital.

Did you know?

After your child gets the rash they are not likely to be contagious, and it is considered safe to send them to school if they are feeling well (7).

6. Rubella (German Measles)

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Rubella sometimes referred to as German measles or the Three-Day Measles, is a contagious viral infection (8). Although it is called German measles, it isn’t caused by the measles virus. Infected children can spread the infection to others one week before and after the appearance of the rash (9).

Typically, a red rash appears on the face and then gradually spreads to other body parts. These rashes may first appear as raised bumps and then combine and form a stretched rash.

The other symptoms that precePetechiae, along with the presentation of these symptoms, warrants medical attention. A doctor may take a few tests to determine the underlying cause of the rashes and manage the symptoms accordingly with antibiotics, corticosteroids, and vitamin Cde the rash are

• Low-grade fever
• Cough and runny nose
• Headache
• Redness or swelling of the white of the eye
• Swollen and enlarged lymph nodes

These symptoms may occur one to five days before the appearance of the rash. As there’s no known medication to treat rubella, the treatment includes the management of symptoms. MMR (Measles-mumps-rubella) vaccine is the most effective way to prevent its occurrence in children.

Besides these, some other viral infections that can cause skin rash in children are dengue, zika, West Nile, smallpox, and eczema (including atopic dermatitis). Some of these viral infections spread to children through insects and not from person to person.

7. Petechial Rashes

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Petechial rashes, or petechiae, are tiny, non-blanching, purple, red, or brown spots under the skin. They appear as 2mm pinpoints and emerge due to bleeding under the skin or in the mucous membranes. These rashes are reported to cause 2.5% of presentations to the pediatric emergency department.

Petechial spots are not oozing, painful, bumpy, raised, or itchy. However, they tend to turn pale on pressure application. Petechiae could be caused by infectious viruses such as enterovirus, parvovirus B19, dengue virus, ebola, and cytomegalovirus. In such cases, children may present symptoms apart from these rashes, including:

• Fatigue
• Fever
• Sore throat
• Cough
• Swollen glands or tonsils
• Body aches
• Nausea or vomiting
• Gastroenteritis

Severe symptoms may also include dizziness or loss of consciousness, trouble breathing, a quick spread of spots, bleeding from mucosal surfaces, and upper gastrointestinal bleeding leading to black stools.

Petechiae, along with the presentation of these symptoms, warrants medical attention. A doctor may take a few tests to determine the underlying cause of the rashes and manage the symptoms accordingly with antibiotics, corticosteroids, and vitamin C supplements (10) (11).

Are Viral Rashes Contagious?

Most viral infections, such as measles and rubella, spread through contact with body fluids, such as nasal and throat discharge, or via air droplets expelled by the infected person. However, some infections, such as chickenpox and HFMD, spread through contact with the fluids from the rash.

The period in which an infected person can spread the infection to others varies depending on the infection type and other factors, such as immunity. For instance, a child infected with rubella stays contagious one week before and after the appearance of the rash, while a child infected with rubeola stays contagious four days before and after the rash.

When Should You Worry About A Viral Rash?

Some viral rashes are self-limiting and resolve on their own. Nonetheless, if your child experiences a persistent viral rash and unusual symptoms, it’s advisable to consult a doctor. Here are some concerning symptoms you should look out for in your child.

• Breathing difficulty and increased heart rate
• The rash appears near the eyes, genitals, and the mouth
• It worsens with time and doesn’t go away after the expected duration
• Persistent high fever
• Stiffness of the neck and pain in the head, neck, and the ears
• Vomiting and dehydration

If you spot any of these signs in your child, consult their doctor to determine the cause of the rash and ensure prompt and appropriate care.

How Are Viral Rashes Diagnosed?

A physical examination of the rash and evaluation of other signs and symptoms that appear before and after the rash can help the doctor diagnose a viral rash (12). Additionally, the doctor will look into the child’s medical history, vaccination records, recent travel history, and if they have come into contact with an infected person.

The doctor may also order other tests, such as blood and imaging tests, to confirm the diagnosis and look for any possible complications of viral rash in children.

Note: A viral rash often looks similar to other types of rashes, and the other symptoms, such as fever and cough, may be present in other illnesses too. Hence, always consult a pediatrician and seek their guidance for the diagnosis and treatment.

What Are The Treatment Options For Viral Rashes?

Mostly, viral rashes are self-limiting and do not warrant any specific medical treatment. However, if the symptoms persist or worsen, it is best to seek healthcare advice. The treatment is focused on offering symptomatic relief, including reducing the duration and severity of symptoms. For instance, a child may be given over-the-counter pain-relief medicines, such as acetaminophen, in the case of fever and moderate pain; ointments, creams, or lotions, such as calamine lotion, to soothe itchy rash; intravenous fluids (IV), antiviral medications, antihistamines, and steroid creams for severe cases of infection.

Note: Do not administer medicines to children without consulting a pediatrician, as some medications may cause an allergic reaction.

Besides these, home care is the most crucial aspect of treating a viral rash. The following steps will ensure that the child recovers from the infection quickly (13).

• Offer the child plenty of fluids, such as ORS (oral rehydration solution), coconut water, and lemonade to replenish fluid loss due to fever.
• Ask the child to wear loose-fitting clothes to prevent sweating and help the child stay at ease.
• Continue feeding the child as usual. If the child doesn’t feel like eating solids, give them semi-solids or liquids until their appetite resumes.
• Encourage the child to take rest and avoid outdoor activities. This is crucial as it can worsen the symptoms and increase the risk of infection spread.
• Help your child sleep soundly. Make them lie with their head raised slightly using some extra pillows to make breathing easier.
• Encourage your child to maintain optimum hygiene by doing the following.
• Instruct them to bathe with lukewarm water and mild soap daily and apply cool compresses over the affected areas.
• Give them tissues to wipe nasal or throat discharge, if any.
• Instruct them to cough and sneeze with their mouth covered.
• Keep a disinfectant handy to clean the surfaces that your child frequently touches to prevent spread.

Besides these, trim the child’s nails and remind them not to scrub the rash. If the rash feels too itchy, ask them to pat it with a clean, soft cloth or tissue.

How To Prevent A Viral Rash?

Viral infections can be best prevented by following optimum hygiene standards and getting routine vaccination. To defend against viral infections, both children and adults must get up-to-date immunization.

As a parent, you, too, need to follow proper personal and environmental hygiene practices as children mimic you.

If the child is infected, keep them at home to prevent the infection from spreading to other children.

A viral rash can happen in most viral infections. Hence, the best way to prevent a viral rash is to avoid infection. While avoiding exposure to viruses isn’t possible, one can minimize the infection risk by taking vaccinations and adhering to optimum personal and environmental hygiene standards.

Image: Dall·E/MomJunction Design Team

Learn how to identify several types of viral rashes in children. Compare symptoms to establish the specific type your child may have and safeguard their well-being.

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Reviewer Author Editor Fact Checker

Maria Carmela Villania-MamauagMD, DPPS

Maria Carmela Villania-Mamauag is a board certified diplomate of the Philippine Pediatric Society with a degree of Doctor of Medicine from Our Lady of Fatima University, Valenzuela City and a Bachelor in Science in Psychology from Saint Louis University, Baguio City which was augmented by a year of Bachelor in Science in Family Life and Child development at the University of the Philippines, Diliman, Quezon City.

Read full bio of Maria Carmela Villania-Mamauag

Swati PatwalM.Sc. (Food & Nutrition), MBA

Swati Patwal is a clinical nutritionist, a Certified Diabetes Educator (CDE) and a toddler mom with more than a decade of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children.

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Rohit GarooBSc, MBA

Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University.

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Dr. Joyani DasM.Pharm, PhD

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer.

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