By Gary M. White, MD
A pink, symmetric, fine, maculopapular or urticarial eruption is typical.
A viral exanthem is a diffuse maculopapular rash that develops as an immune response to a viral infection.
|Season||Spring, Summer||Fall, Winter|
|Location||Buttocks, hands and feet, and face||Proximal trunk and extremities|
|Morphology (beyond Maculopapular)||+-Petechiae or vesicles||Dusky +- petechiae|
|Symptoms||Conjunctivitis, cough, diarrhea, fatigue, headache, insomnia, irriability, sore throat, and vomiting.||Diarrhea, sore throat.|
|Signs||Fever, hepatomegaly and lymphadenopathy||Can have low-grade fever|
|Enanthem (changes in the mouth)||Yes||No|
Differentiating from a drug hypersensitivity may be difficult. The presence of petechiae and vesicles are highly suggestive of infection. Papules and pustules are more typically drug-related. The presence of enanthem points strongly toward infection.
The clinical appearance can be quite variable. The classic appearance is a non-specific diffuse maculopapular exanthem. However and perhaps because so many viruses can be causative, other presentations are seen. For example, the rash may localize just on the hands and feet and mouth (e.g. Hand, foot, and mouth disease). Or it may localize to the knees and axilla. In some, the rash may involve the face, in others not. Occasionally, the rash is vesicular (e.g. chickenpox). Most are truncal, but some are acral (e.g. Gianotti-Crosti syndrome). An unusual type localized to the hands and feet is called Gloves and Socks Syndrome.
|CMV||Asymptomatic or Infectious mononucleosis|
|Epstein Barr Virus||Infectious mononucleosis, Gianotti-Crosti Syndrome|
|Human herpesvirus-6 and -7||Pityriasis rosea, Infectious mononucleosis|
|Parvovirus B19||Erythema infectiousum (slapped cheeks), Gloves and Socks Syndrome, arthralgia, purpura|
|Chikungunya, Dengue and Zika|
|Enterovirus, Coxsackie virus, Echovirus||Hand, foot and mouth|
Only supportive therapy is needed, e.g. rest and acetominephin. Other family members could be affected. Advise the patient to contact you if blisters, vesicles or oral lesions appear. If the patient is in significant discomfort, e.g. itch, systemic steroids may be given, e.g. 1 mg/kg and tapered over 10-14 days.
Oral ulcerations accompanying a viral exanthem.
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