Many childhood illnesses are associated with a rash.  Parents often fear that illnesses with rash are more dangerous than those without.  This is usually not so.  Rashes are associated with very mild and serious illnesses alike; many serious illnesses have no rash at all.

By far, the most common infection-related rash is the nonspecific type which accompanies many respiratory and gastrointestinal viruses.  This rash is usually made up of small red bumps over the chest, abdomen and back.  The spots will fade momentarily when pressed.  The face and limbs may also be involved.  No treatment is required for a nonspecific viral rash.  It resolves on its own within days to a week.

Other infection-related rashes are distinct due to their consistent appearance and association with other symptoms.  Several such rash illnesses are described below.


Until the 1990’s chickenpox, (varicella), was a common childhood disease.  Now, with the widespread use of chickenpox vaccine, very few children are ever affected.  However, sporadic cases still occur.  The majority of cases are of the mild (attenuated) variety seen in incompletely immunized children.  In classic disease, itchy red pimples appear in successive crops, turn into blisters and eventually rupture and crust.  There are generally fewer, smaller and less itchy spots in attenuated chickenpox.  Fever, cold symptoms and secondary skin infections are uncommon in children who have had at least one dose of chicken pox vaccine.  Incubation period for chicken pox is 10-16 days.  Daily bathing will reduce the chance of secondary skin infection.  Oral diphenhydramine (Benadryl), calamine lotion and oatmeal baths may help with itching. We highly recommend the chicken pox vaccine to avoid this disease.

Fifth Disease (Erythema Infectiosum)

The rash of Fifth Disease begins with a bright red, “slapped cheek”, eruption on the face.  As the cheeks begin to fade, a lacy-appearing rash spreads down over the body.  Children do not feel ill with Fifth Disease.  Fifth is caused by human parvovirus B19.  It is contagious before the onset of the characteristic rash.

There is often concern about the effect of this virus on unborn children.  Fetal harm can result when a previously unexposed woman is infected early in her pregnancy.  Because the majority of pregnant women have antibodies to Fifth Disease (from previous infection) and because children with identifiable Fifth Disease are no longer contagious, routine separation of pregnant women from children with Fifth is NOT necessary.  If you are pregnant and have concerns about an exposure to Fifth Disease, talk with your obstetrician about blood testing to confirm your immunity.

Hand, Foot and Mouth Disease

This illness gets its name from the characteristic distribution of the spots.  They are small (1/8″) oval-shaped flat blisters on the palms and soles and small sores in the mouth and throat.  Young infants can also get spots on their bottoms.  It is caused by the Coxsackie virus.  Fever and a sore mouth and throat are the main symptoms of this illness.


Except for occasional outbreaks, measles is quite uncommon in properly vaccinated children. The rash starts after 2-4 days of high fever, a hard cough, and red, draining eyes.  The rash is heaviest on the face, chest and back, but also covers the arms and legs.  The red spots are about 1/8″ across and so thick they tend to run together.


Of all the rashes listed here, this is the only one which represents a true emergency.  Luckily, it is extremely rare.  Meningococcus, a.k.a. Neisseria meningitidus, is a bacteria that causes meningitis.  It causes a distinctive dark red to purple rash on the hands and feet.  These flat spots start out small but eventually grow together in large patches. These spots do NOT fade when pressed upon and cannot be felt.  Associated symptoms include fever, profound lethargy and stiff neck.  If you suspect this illness in your child, please contact us immediately.


This virus causes infants to run a fever for 2-3 days without other symptoms except fussiness and swollen lymph nodes at the base of the skull.  The rash doesn’t appear until the fever breaks.


Associated with strep throat, scarletina in made up of pin-point size bumps which are closely spaced mainly on the torso. It feels like sandpaper.  Remember though, not all sore throats with a rash are due to strep.

Urticaria or Hives (whelps)

These itchy, red swollen plaques are most frequently associated with allergy, but often occur with viral infections, too.  It is rarely dangerous.  Diphenhydramine (Benadryl) will often improve the appearance and itching of hives.