Bacterial and Viral Rashes

Many childhood diseases have bacterial or viral causes and include a rash of some type. As additional vaccines become available, these diseases become less of a threat to your child's long-term health. A rash of any kind should be taken seriously, however, and may require a trip to the doctor's office for evaluation. Examples of bacterial and viral rashes include several common childhood illnesses.

Chickenpox (varicella)

A virus called varicella-zoster causes this very contagious disease. The disease is not harmful to most children. The symptoms generally last two weeks and can make the child very uncomfortable. In addition, chickenpox can be a serious illness in people with weak immune systems such as newborns, people on chemotherapy for cancer, people taking steroids, pregnant women, or those with HIV/AIDS. A safe and effective vaccine is now available to children aged 1 year or older to prevent chickenpox. The symptoms generally appear 10-21 days after exposure.

• Symptoms



• The earliest symptoms of chickenpox are fever, sore throat, and feeling tired. This is followed, usually within a day, by the appearance of the classic, intensely itchy rash which typically begins on the scalp, armpits, or groin area.



• The rash begins as an area of redness with a small, superficial blister in the center. The blister eventually ruptures, and the lesion will form a crust.



• Children with chickenpox will have both new and older lesions present at the same time.



• Treatment



• The virus is spread primarily from the nose and mouth of the child, but the rash itself is also contagious. The child remains contagious and cannot go to school or day care until the last lesion to appear has fully crusted over.



• There is no "cure" for chickenpox once it has begun, but there is a vaccine that is very effective in preventing the disease. Once a child has chickenpox, a physician can prescribe treatments to help control the itching and make your child more comfortable.



• The chickenpox vaccine, called the "varicella vaccine" was added to the routine childhood immunizations in 1995. It is given in two doses. The first dose is given at 12 to 15 months of age. The second dose is recommended between ages 4 and 6. The vaccine is both safe and effective. The vaccine can cause mild tenderness and redness at the site for a few days. While most children will be protected by the vaccine, some children who are later exposed to chickenpox can develop a mild chickenpox case usually without fever and with very few lesions. A new tetravalent vaccine against measles, mumps, rubella and chickenpox was introduced in 2005. It has been shown to work as well as the separate MMR and chickenpox vaccines.



• Never give aspirin to a child with chickenpox. A deadly disease called Reye syndrome has been associated with children taking aspirin, especially if they have chickenpox. Be sure to check any other over-the-counter medications for the ingredients aspirin or salicylates because these are often found mixed with over-the-counter cold medications.



• Chickenpox can occasionally affect the cornea, the clear front portion of the eye. If your child develops chickenpox on the tip of the nose or in the eyes, or if the child develops a red, irritated eye, you should see your doctor immediately.

Measles

A Paramyxovirus causes the measles. A safe and effective vaccine is available to prevent this disease, but outbreaks in people who have not been fully vaccinated still occur.

• Symptoms



• The disease usually begins with nasal congestion, eye redness, cough, and fever.



• The child will generally look sick, with decreased appetite and activity level.



• On the third or fourth day of the illness, the child will develop a brown rash on the face, which spreads down the body and lasts more than three days.



• Treatment



• Once the disease begins, no medication is available to treat measles.



• Children who have measles appear quite ill and are miserable, but the illness usually gets better without lasting ill effects.

You can prevent your child from getting measles by making sure they receive the recommended vaccines. The measles vaccine is part of the MMR (measles-mumps-rubella) vaccine given at age 12-15 months and repeated at age 4-6 or 11-12 years. In the past, some parents would elect to skip this vaccine because of concerns of association between vaccines and autism. Multiple recent studies have shown the vaccine to be safe and definitely not associated with autism or any other behavioral abnormality. The safety concerns focused on the vaccine preservative, thimerosal, which contains mercury. The studies on thimerosal have shown it to be safe, and its use is still endorsed by the World Health Organization (WHO). The MMR vaccine and the DTaP vaccines in the United States have been thimerosal-free since 1995. Since 2001, with the exception of some influenza (flu) vaccines, thimerosal has not been used as a preservative in routinely recommended childhood vaccines in the U.S.

Rubella (German measles)

Rubella is a much milder disease also caused by a virus (Rubivirus).

• Symptoms



• Rubella begins with a pink rash on the face then spreads to the body. Symptoms improve in less than three days.



• Your child does not appear to be very ill but may develop swollen lymph nodes in the neck, especially behind the ears.



• Treatment



• Rubella is also easily prevented with an effective vaccine (the MMR).



• Rubella can be very serious to an unborn child if the mother develops rubella early in her pregnancy. All women of childbearing age should have their immune status verified.

Scarlet fever (scarlatina)

Scarlet fever is simply strep throat with a rash. The throat infection is caused by the bacteria group A streptococcus pyogenes. It is most commonly seen in school-aged children in the winter and early spring, but it can occur in individuals of any age and in any season. It is very contagious, and the risk of transmission can be decreased with good hand washing.

The rash is not serious, but serious complications can occur from the underlying infection, strep throat. The most worrisome of these is rheumatic fever, a serious disease that can damage the heart valves and cause long-term heart disease.

• Symptoms



• The child's symptoms begin with sore throat (which can be mild), fever, headache, and swollen glands.



• After one to two days of these symptoms, the child develops a rash on the body that is red and has a sandpaper roughness. The rash usually spares the palms and soles.



• The face may look very flushed with a thin ring of normal skin around the mouth.



• Treatment



• Streptococcal sore throat can be treated with antibiotics.



• Have your child seen by your doctor immediately if you suspect he or she has strep throat or scarlet fever.



• Your child will require a full course of antibiotics, which should be finished even if your child is better before completion.



• Your child may return to school in 24 hours if the fever has resolved and he or she is feeling better.

Fifth disease

Fifth disease, also known as erythema infectiosum or "slapped cheeks" disease, is caused by a virus (parvovirus B19). This disease tends to occur in the winter and spring but can occur year-round.

• Symptoms



• Most people with a parvovirus B19 infection will have no symptoms. Only one in four will develop Fifth's disease.



• The disease can cause a low-grade fever, headache, sore throat, nausea, vomiting, and/or diarrhea in the eight to 10 days before the rash appears. The rash only appears once the viral illness is over.



• The earliest specific sign of the disease is often bright red cheeks, inspiring the name "slapped cheeks disease."



• In one to two days, a lacy, red rash spreads throughout the body. The rash appears to fade when the skin is cool, but with a warm bath or with activity, the rash becomes more pronounced.



• Occasionally the child may have sore joints with the rash.



• Once the rash appears, the child is no longer contagious.



• Treatment



• Fifth disease is not serious in otherwise healthy children but can pose a serious problem for children with sickle cell anemia, leukemia, or HIV/AIDS.



• The disease can also cause problems for pregnant women.



• Because the child is contagious only before the rash appears, children who develop the rash are free to return to day care.

Roseola infantum

Roseola is also called exanthem subitum and is a common childhood illness caused by the human herpes virus 6. The human herpes virus 7 can less commonly cause this disease. The disease usually occurs in children younger than 2 years.

• Symptoms



• The symptoms are a high, spiking fever for two to five days followed by the onset of a rash.



• The rash appears as the fever resolves. It consists of small, pink, flat, or slightly raised lesions that appear on the trunk and spread to the extremities.



• The rash resolves quickly, usually only lasting one to two days.



• Treatment



• Despite the worrisome fever, the disease is not harmful and gets better without specific therapy.



• The fever associated with roseola can occasionally cause a seizure.

Coxsackieviruses and other enteroviruses

The enteroviruses, including the coxsackieviruses, are a very common cause of fever and rash in children. Two diseases are caused by coxsackieviruses, called hand-foot-and-mouth disease and herpangina. Coxsackievirus infections are more common in the summer and autumn.

• Symptoms



• In hand-foot-and-mouth disease, the children develop fever and rash. The rash includes tender blisters in the mouth and tongue as well as on the palms and soles of the hands and the feet. Occasionally the rash will also occur on the buttocks or the genital area.



• Herpangina causes a fever, sore throat, and painful blisters or ulcers in the back of the mouth. It typically occurs during the summer months.



• Treatment



• No specific treatment is available except acetaminophen (Tylenol) or ibuprofen (Advil) for fever and discomfort.



• The diseases are not harmful but can be prevented with good hand washing and not eating off of someone else's plate or sharing straws.

Impetigo

Impetigo is a superficial skin infection caused by streptococcal or staphylococcal bacteria. It is often found around the nose and mouth but can occur anywhere. The rash is more common in the warmer months. It can also occur as a secondary infection in skin that has been damaged, such as with scabies, poison ivy, eczema, or drug reactions.

• Symptoms



• Impetigo begins as small superficial blisters that rupture, leaving red, open patches of skin.



• Often a honey-colored crust forms over this rash.



• The rash may be quite itchy.



• Impetigo is also highly contagious. A child can spread the infection to other parts of the body or to other people.



• Treatment



• This infection of the skin is easily treated with topical or oral antibiotics.



• Your child usually is no longer contagious after two to three days of therapy, and the rash begins to heal in three to five days.



• If the rash does not show signs of healing by the third day of treatment, your child needs to be seen by a doctor.



• When the impetigo occurs in addition to poison ivy or scabies, your child may benefit from an anti-itch medication while the antibiotics are taking effect.