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Viral infections are common in babies and young children. They often cause minor rashes on the skin. The rashes can have different appearances such as flat red areas, many small raised bumps, blisters, weals or any combination of these.

Different viruses may be associated with different rashes, although occasionally different viruses can cause the same rash. It is frequently difficult to tell exactly which virus is causing a skin rash. A variety of common viral infections associated with skin rashes are described below. These conditions are infectious and are spread by direct contact.

ROSEOLA INFANTUM
This viral infection is the most common illness causing fever in children under the age of two years. It is most common between the ages of 6-9 months. Fevers with temperatures of 39-40ºC begin suddenly and last for 3-5 days. The child is otherwise well apart from some mild irritability. The glands around the neck become enlarged and then as the temperature falls, a rose-pink coloured rash develops on the neck and the body. It may spread to the arms, face and legs and fades within 1-2 days. It is not itchy. No treatment is needed for the rash.

HAND, FOOT AND MOUTH DISEASE
This viral infection is seen most commonly during summer and autumn in young children. It is not the same viral infection that causes foot and mouth disease in farm animals. The symptoms are usually mild and last about seven days with a slight fever initially. The mouth develops small blisters that often break to form small ulcers. Small pearly grey, oval shaped blisters with a narrow red edge can occur on the fingers, the toes and around the side of the heels. The number of small blisters varies and they fade over 2-3 days. They are not itchy or painful. No treatment is needed.

ERYTHEMA INFECTIOSUM (SLAPPED CHEEK OR FIFTH DISEASE)
Small outbreaks of this viral infection occur around springtime and most cases are seen in children aged between 2-10 years. The rash occurs on the cheeks, which become very hot and red (hence the name "slapped cheek disease"). It develops over 24 hours and fever, if present, is usually mild. The rash may spread onto the body in a lace-like pattern. It usually fades within 6-10 days. After that, if the child becomes hot or is out in the sunlight, the rash may reappear on the arms or legs over the next couple of weeks. No treatment is needed for the rash.

MEASLES
Measles is far less common now due to immunisation. However, it has not been entirely removed from the community. The first symptoms of this viral infection include fever, cough, a runny nose and red, sore eyes, which last 3-5 days. The child will generally feel unwell with lack of energy and irritability. Bluish white spots with a red rim develop on the inside of the cheeks on the second day. On the fourth day a red rash occurs on the forehead and behind the ears, spreading within 24 hours to the rest of the face and the body. The rash fades after a week leaving a brownish stain on the skin, which may peel. In most cases, the infection settles completely without any major complications. There is no specific treatment for the rash but the child should be kept in bed or resting, be given plenty of water to drink and avoid bright light. Paracetamol suitable for young children may be given to help ease the fever.

Your Maternal and Child Health nurse.
Your pharmacist.
Your family doctor.
A dermatologist.

© 2002, Department of Dermatology, St. Vincent’s Hospital Melbourne, Victoria Parade, Fitzroy, Victoria 3065 Australia.