Skin Rashes in Children (cont.)
Symptoms of Viral Rashes
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. 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 of chickenpox generally appear 10-21 days after exposure.
- 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 that typically begins on the head and torso and then spreads outward to the arms and legs. The total duration of the rash is seven to 10 days.
- The rash begins as an area of redness with a small, superficial blister in the center. After one to two days, the blister ruptures and the lesion will form a crusty scab that will fall off in two to three days. This entire evolution takes four to five days.
- Thus, children with chickenpox will have new outbreaks of the initial lesions as older crusted lesions are resolving. They characteristically will have both new and older lesions present at the same time.
Measles ("Regular" or "Hard" Measles)
A Paramyxovirus causes measles. A safe and effective vaccine is available to prevent this disease, but outbreaks in people who have not been fully vaccinated still occur.
- Initial symptoms generally appear 10-12 days after exposure to this highly contagious virus.
- The disease usually begins with nasal congestion and cough, eye redness without discharge, and moderate fever (102 F-103 F).
- The child will generally look sick, with decreased appetite and activity level.
- On the third or fourth day of the illness, a higher fever (104 F-105 F) develops and the child will develop a brown rash on the face, along the hairline, and behind the ears. The rash then spreads down the body to the thighs and feet. After approximately a week, the rash fades in the same pattern as it developed.
Rubella (German Measles or "Three-Day Measles")
Rubella is a much milder disease than "regular" measles and is also caused by a virus (Rubivirus).
- Rubella is purely a disease of humans and is spread by virus in nasal and oral secretions.
- Following an incubation period of 14-21 days following viral exposure, the infected child will develop a pink or light red rash on the face that then spreads to the body. The rash does seem to itch to a mild degree. Other symptoms, which improve in three days, include low-grade temperature (100 F), headache, mild joint pains, conjunctivitis without discharge, and swollen lymph nodes in the neck and especially behind the ears.
- Generally children do not appear to be very ill especially when compared to those suffering from measles.
- 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. Complications include congenital rubella syndrome. Congenital rubella syndrome occurs when intrauterine infection occurs during the first trimester. Complications involving the brain, heart, vision, hearing, and liver of the infant may be life threatening.
Fifth disease, also known as erythema infectiosum or "slapped cheeks" disease, is caused by a virus (parvovirus B19). This infection tends to occur more commonly in the winter and spring but can occur year-round. Infection tends to occur after an incubation period of four to 14 days.
- Parvovirus B19 infection is strictly human-to-human in nature. While there are animal parvovirus infections, these do not affect humans. Most people with a parvovirus B19 infection will have no symptoms. Only one in four will develop fifth disease. The vast majority of infections occur during childhood, and infection conveys lifelong immunity.
- Fifth disease often starts as a " cold" -- nasal congestion with slight cough, headache, mild sore throat, and low-grade fever. The rash only appears immediately after the symptoms of the viral illness are over and the child is no longer contagious.
- The earliest specific sign of the disease is often bright red cheeks, inspiring the name "slapped cheeks disease."
- After one to two days, as the slapped cheek appearance fades, and a lacy, red rash spreads throughout the body and is most commonly found on the arms. 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. Adults who contract Parvovirus B-19 infection are more likely to report soreness of the joints of the hands, knees, and elbows.
- Once the rash appears, the child is no longer contagious. However, people
with fifth disease who have weakened immune systems may be contagious for a
longer amount of time.
Roseola is also called exanthem subitum and is a common childhood illness caused most commonly by human herpes virus 6. Human herpes virus 7 is less commonly the cause of this disease. A great majority of individuals who contract this disease are children between 6 months and 2 years of age. There is no seasonal variation.
- The classic symptom sequence of roseola is that of an abrupt onset of a high, spiking fever for two to five days without other significant respiratory or intestinal symptoms. The fever breaks and is quickly followed by the onset of a rash.
- The rash consists of small, pink, flat, or slightly raised lesions that appear on the trunk and spread to the extremities.
- The rash is not bothersome and resolves quickly, usually only lasting one to two days.
Coxsackieviruses and Other Enteroviruses
The enteroviruses, including the coxsackieviruses, are a very common cause of fever and rash in children. Two common diseases caused by coxsackieviruses are hand foot and mouth disease and herpangina. Coxsackievirus infections are more common in the summer and autumn. All childhood age ranges are susceptible.
- In hand foot and mouth disease, children develop a moderate fever for one or two days and then a characteristic 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. Young children have a general feeling of being ill (malaise) and are often cranky with a depressed appetite. The incubation period following exposure is five days.
- Herpangina causes a fever, headache, sore throat, and painful blisters or ulcers in the back of the mouth. It typically occurs during the summer months and is most commonly seen in children between 3-10 years of age. A diminished appetite is common as a consequence of mouth pain. The incubation period is seven days.
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