Measles, Rubella, Chickenpox…OH MY!

WORDS Dr. Kendall Wagner, Chaffee Crossing Clinic
IMAGE svtdesign/Shutterstock

Jun 1, 2023 | Featured, Health


Rashes caused by viruses are quite common in children. While most of these rashes resolve without treatment and require only supportive care such as Tylenol or Ibuprofen to ease symptoms, they can cause parents anxiety and increase doctor visits. Childhood vaccinations have significantly reduced the occurrence of measles, rubella, and chickenpox; however, viral rashes continue to be prevalent with viral illness.

Measles, the most dangerous from a morbidity standpoint, is now the least occurring in children. A robust and long-standing vaccination program has significantly reduced the occurrence of measles in the U.S. population. Early symptoms of measles are consistent with conjunctivitis (redness of the whites of the eyes), fever, runny nose, and a persistent nighttime cough. The measles-associated rash begins at the neck’s hairline and extends outward, evolving into a red, raised rash that merges into one continuous raised, red area. The infection causes the immune system to be temporarily impaired, which can lead to bacterial complications such as ear infections and pneumonia. Unfortunately, the measles virus infection can also cause brain inflammation, which results in neurological symptoms.

Rubella is another viral illness significantly reduced by vaccination. Like measles, early symptoms of rubella are headache and low-grade fever, followed by a raised, red rash which spreads from the neck down to the feet. Unlike measles, it does not merge. Enlarged lymph nodes on both sides of the neck, especially behind the ears and the back of the neck, are common. The most prominent complication of rubella is its effect on a developing fetus during pregnancy, leading to various conditions ranging from spontaneous pregnancy loss to congenital disabilities.

Chickenpox is a viral illness caused by the varicella-zoster virus. While the prevalence of chickenpox is greatly reduced by vaccination of infants and children entering school, a significant number of infections still occur in pockets of the population, especially where immunization rates are low. Chickenpox symptoms include fatigue and irritability followed by fever and an itchy rash on the face, body, underarms, and upper and lower extremities. The rash starts as red bumps that develop fluid-filled surfaces called vesicles. Complications may include the breakdown of muscles, effects on vision if the eyes are affected, and inflammation of the brain or spinal cord, known as encephalitis or meningitis.

Individuals previously infected by the chickenpox virus are also susceptible to a secondary complication known as shingles. Shingles occurs when the chickenpox virus, hidden in the individual’s nerve cells for several years, suddenly reactivates during sickness or stress. This reactivation causes a painful, red, often bumpy rash that appears in bands, commonly on the torso, but can occur anywhere on the body’s surface. The pain associated with shingles may last for months to years in a condition known as post-herpetic neuropathy. A vaccine is available to adults infected by the chickenpox virus as children, which can prevent the reactivation of the hidden virus, thus preventing shingles.

Fifth disease, also known as slap-cheek disease, is another common illness in children worldwide. This viral illness, caused by Parvovirus B19 leads to an infection, primarily in red blood cells. Symptoms often include marked redness of the cheeks and a lacy rash pattern with a hive-like appearance. The rash is a reaction of the body’s immune system against the virus. While the rash resolves without treatment in most patients, some may experience joint pain and anemia due to red blood cell damage caused by the virus. This viral illness generally requires no specific treatment, only supportive care.

Roseola, sometimes called three-day fever and sixth disease, is the most common viral illness in infants and young children. This viral rash is the body’s immune response to human herpes virus type 6 or 7 (HHV-6/HHV-7). Symptoms begin with a high fever for three to five days, followed by a raised, red, bumpy rash that appears on the neck and body, which disappears over several hours. Febrile seizures are often present during the fever phase of the illness.

Hand-foot-and-mouth disease is another common pediatric illness caused by coxsackievirus or enterovirus. It is associated with painful sores in the mouth and painful, red bumps that occur primarily on the hands, feet, and buttocks. The illness begins with fever and sore throat, followed by the appearance of a rash within twenty-four to forty-eight hours. Painful sores in the mouth can lead to dehydration, so care is taken to ensure patients are taking in enough fluids. The illness lasts, on average, seven days and is highly contagious, which can cause large outbreaks in daycare centers and preschools. This viral illness generally requires no specific treatment, only supportive care.

While rashes, especially in pediatric patients, can be very scary for parents and children alike, they usually resolve independently without needing medication. Your physician will likely identify the cause of the rash by observing its qualities and distribution. While vaccinations have significantly reduced these infections and most viral rashes are not a cause for alarm, early identification is essential, especially for measles and chickenpox, so spread can be limited and the virus contained as quickly as possible.

Photos of childhood rashes and many others can be found at; search visual guide to children’s rashes and skin conditions.

Kendall Wagner, M.D. is a regular healthcare contributor to Do South® magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas

Do South Magazine

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