Viral Rashes in Children

Many are No Longer Common Due to Immunization Efforts

Sep 30, 2009 Stephen Allen Christensen

Many common pediatric viral infections are associated with rashes. Owing to vaccination programs, most of these conditions aren't as prevalent as they were 20 years ago.

Very few Americans remember seeing someone with smallpox, although anyone born in the U.S. before 1972 may bear memories of smallpox vaccinations. This frequently fatal disease was effectively eradicated in 1977, mainly due to worldwide immunization efforts.

Although many people remain opposed to vaccination programs, widespread immunization of children in the United States is responsible for reducing the prevalence of once-common pediatric illnesses.

Because some parents fear the complications of vaccinations – or, for various other reasons, fail to immunize their children – most rash-associated (exanthematous) viral illnesses persist within the population. From time to time, small epidemics occur when one of these diseases erupts among an unimmunized or incompletely-immunized group of people.

Occasionally, complications from one of these diseases still cause death or lifelong disability.

Preventable Exanthematous Illnesses in Children

(Information adapted from Infectious Diseases in The Merck Manual, 18th Edition, 2006)

Rubeola (Measles; “Hard” Measles)

• This highly contagious disease is spread through airborne droplets and secretions from the nose, throat, and mouth of infected persons.
• Incubation (the time from infection to appearance of symptoms) is 7 – 14 days. Onset is characterized by fever (occasionally to 104º F), cough, runny nose, and sometimes impressive conjunctivitis (red eyes).
• Two to four days later, classic Koplik’s spots – red dots with a central “rice grain” – appear on the inner cheeks. One or two days after that, a reddened, blotchy rash begins on the face and neck and quickly spreads to the trunk and extremities; the palms and soles are usually covered, as well.
• Three to five days after it erupts, the rash fades, the fever falls, and most patients recover.
• Measles kills 2 of 1,000 patients in the U.S., but mortality is much higher in developing countries. Vitamin A deficiency appears to worsen the course of the disease.
• Complications include secondary bacterial infections (pneumonia, ear infections, cellulitis, etc.) and decreased platelet counts that lead to transient bleeding abnormalities.
• Measles encephalitis affects 1 in 1000 patients, usually beginning in the first week of the illness and heralded by high fever, headache, seizures, and coma. Survivors usually recover after a week or two but are frequently left with learning disabilities and other neurologic problems.
• A late complication of measles, which may occur years after the initial infection, is subacute sclerosing panencephalitis. This probably represents a reactivation of the measles virus within the brain. It is usually fatal.

Rubella (“German Measles")

• Rubella is acquired through close contact with an infected person; the virus is transmitted in respiratory droplets.
• Following a 14- to 21-day incubation period, patients exhibit a few days of fever, chills, body aches, and sore throat. The lymph nodes (“glands”) behind the ears and along the back of the neck may be swollen. Purplish “blood blisters” may appear on the soft palate.
• Rubella’s rash is similar to, but less severe than, that of measles: It begins on the face and neck and quickly spreads to the trunk and extremities. A day or two after eruption, the rash becomes pinpoint-like, with an underlying reddish flush; it resolves in 3 – 5 days.
• Rubella encephalitis rarely occurs, and it usually resolves without complications, but fatalities do occur.
• Rubella’s primary impact is on the fetuses of unimmunized pregnant women: Multiple congenital defects (deafness, cataracts, mental retardation, decreased head size, etc.), spontaneous abortions, and stillbirth result from intrauterine infection.

Varicella (Chickenpox)

• Chickenpox is a highly infectious disease caused by the varicella-zoster virus, a member of the herpesvirus family. It is spread by respiratory droplets; the illness is most contagious during its early phases, including the two days before the rash erupts.
• Eleven to fifteen days after exposure, infected individuals develop fever, body aches, headache, and mild cough.
• A day or two after initial symptoms, the characteristic rash of chickenpox appears: Reddish spots first erupt on the face and trunk, progress rapidly to small bumps with central teardrop blisters, spread to the rest of the body (often including the mucus membranes), and recur in successive crops.
• New spots usually stop appearing within five days, and most of the rash is usually crusted by the 10th day, at which time contagiousness stops.
• Itching can be significant. The crusted rash may take three to four weeks to disappear.
• Complications of chickenpox include secondary bacterial infections (pneumonia, cellulitis, and toxic shock syndrome), myocarditis (inflammation of the heart muscle), arthritis, hepatitis, and bleeding problems. Reye’s syndrome occasionally occurs.
• Encephalopathy occurs in 1 to 2 of 1000 cases, often as the rash is resolving. This usually resolves, but permanent neurologic injury (palsies, gait disturbances, weakness, incontinence, and a multiple sclerosis-like syndrome) or even death may ensue.
• Chickenpox can be far more severe in adults than in children.

The value of widespread immunization is manifest in the relative rarity of present-day complications caused by once-common diseases.

The copyright of the article Viral Rashes in Children in General Medicine is owned by Stephen Allen Christensen. Permission to republish Viral Rashes in Children in print or online must be granted by the author in writing.

Chickenpox Rash

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