Going VIRAL (Rashes Part 2)

“O no, keep your child away from mine… your child has a rash, it must be contagious!” Because a rash is such a visible symptom, it is easy to blame such-and-so for giving your child chicken pox or measles, but is it really the case? For how long are these diseases contagious, and when should you worry or report it when your little one suddenly has a rash on his back at bath-time? I am spending a little time today on the viral causes of red rashes. I have combined some of the skin-knowledge from Dr Knight and Dr van der Walt with my pediatric knowledge to give you a summary of the most common diseases.

“Yawns are not the only infectious things out there besides germs. Giggles can spread from person to person. So can blushing. But maybe the most powerful infectious thing is the act of speaking the truth.” 

Vera Nazarian

Dependent on the shape / spread / type, rashes are commonly due to viral diseases, mostly resolve spontaneously and can accompany almost any common cough, cold, sore throat and tummy bug. Read on to learn about a few more specific viral culprits:

1.Measles (Rubeola virus)

• Type of Rash: Starts 2-4 days after the fever started. Red spots that starts on the face and spreads to the body, usually not itchy, can look as if the spots flow together. Blanches when looked at through a glass. Rash darkens after a few days
• Other Symptoms: Fever (as high as 40degrees), malaise (tiredness), cough, runny nose, white spots on the inside of the cheeks (Koplik spots) and conjunctivitis (red eyes), followed by the rash.
• Treatment: Supportive* (see below), Vitamin A (proven to reduce severity and mortality). No specific treatment available for the virus. Vaccinations available to prevent severe infections and stop the spread. Report to your local health worker as outbreaks are possible.
• Contagious? Five days before the rash appears until 4 days after it disappears. Spreads by droplets from the airways.

2. German Measles (Rubella virus)

• Type of Rash: Pinpoint, pink rash (similar to measles) starts in the face and spreads to the rest of the body within 24hours. Usually not itchy.
• Other Symptoms: Usually very mild, may have fever (as high as 40degrees) and typical pattern of enlarged lymphnodes behind the ears / at the hairline.
• Treatment: Supportive care * No specific treatment available for the virus. Vaccinations available to stop the spread and especially to prevent congenital     rubella.***
• Contagious? 1-2weeks before the rash appears. The distribution of the virus stops once the rash is visible. Spreads by droplets from the airways.

*** Very dangerous to the unborn baby if a pregnant mother is exposed to the virus. Make sure you have immunity before becoming pregnant.

3. Chicken pox (Varicella virus)

• Type of Rash: Red spots quickly turn to blisters that heal with scabs. The key feature here is that there will be new blisters as well as scabs signaling old lesions at the same time (referred to as cropping). Appears all over the face and body and is very itchy.
• Other Symptoms: Fever (low grade), malaise, sore throat, decreased appetite about 24hrs before the rash starts.
• Treatment: Supportive care*. Oral antihistamine medication may help with the itching. Keep nails short to prevent secondary bacterial infection and scar formation. Use Paracetamol for fever. DO NOT USE aspirin as there is an increased risk of developing Reye syndrome in children with chicken pox. Anti-viral (Acyclovir) available, but only for adults or children with high risk of developing complications.  Vaccination available to decrease severity and stop spread. Report to your local health worker as outbreaks are possible.
• Contagious? Two days before the rash appears until all the lesions are crusted and there are no new lesions. Spreads by droplets from the airways, AND by direct contact with fluid from the blisters.

4. Hand, Foot and Mouth disease (Coxsackie virus, also some other enteroviruses)

• Type of Rash: Painful, red spots which changes to blisters on the tongue and inside of the cheeks. Rash on the handpalms / fingers / soles of the feet / diaper area can be red spots or blisters.
• Other Symptoms: Mouth or throat pain, refusal to eat, low grade fever, abdominal pain
• Treatment: Supportive care.*  No specific antiviral medication available. Hospitalization may be necessary if your child is dehydrated or if there are signs of neurological complications. No vaccination available.
• Contagious? Spreads by faecal-oral route (virus is thus shed in your baby’s stool and spread wherever you touch), also from droplets from the airways, direct contact with fluid from the blisters. Children can continue to spread the virus for up to 4-6weeks after the infection started.

5. Roseola infantum (Human Herpesvirus-6)

• Type of rash: Another cause of a red spotty rash that starts on the face and spreads to the body. Lasts for a few hours or up to 2 days.
• Other symptoms: 3-5 days of high fever (can be >40°) in children under 2 years. Usually not any other symptoms. Fever stops suddenly and then the rash is seen.
• Treatment: Supportive care.*
• Contagious? Not very contagious. Spreads by secretions to people in close contact.

6. Erythema infectiosum / Slapped cheek disease (Parvovirus B19)

• Type of rash: Starts 2-5 days after other symptoms with bright red cheeks (slapped cheek) followed by a lace-like red rash on the body.
• Other symptoms: Non-specific flu-like symptoms. Parvo B19 infection can also be associated with joint-pains and it can also affect the bone-marrow causing a severe anaemia. Can be very dangerous to the fetus if a pregnant woman develops this disease.
• Treatment: Supportive care.* No vaccination available.
• Contagious? Virus is shed for 5 days before symptoms start via droplets from the airways. Can also be spread via the placenta to the fetus or via blood-products.

*Supportive treatment of viral diseases:

• Antipyretics (see my post on the treatment of fever) to improve the discomfort.
• Rest.
• Fluids. Make sure your little one stays hydrated. They will probably not be very hungry so try to give some smoothies / juices / milk to increase their calorie intake too.
• Treatment of bacterial infections that develop on top of the viral infection.

Most of these viral diseases are seen as “normal childhood diseases”. All of them could also have severe complications in otherwise healthy children. Please use the available vaccinations to prevent severe illness and more importantly to stop the spread of these viruses. As you can see the viruses are all contagious BEFORE any symptoms are visible, making it almost impossible to know if your child will infect a pregnant mother and her unborn baby, or the premature baby just out of hospital or the child with a transplant or immune-deficiency. Schools and your doctor can give you further advice regarding how long you should keep your child home.

May you be blessed with an extra dose of TLC to give your little spotty-kiddo! Be sure to come back soon for some advice on bacterial rashes!

“Come to me, all you who are weary and burdened, and I will give you rest.”

Matthew 11:28

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Pictures from kidshealth.org and Google images.