Characterizing Viral Exanthems

Joseph M Lam

Disclosures

Pediatr Health. 2010;4(6):623-635. 

In This Article

Abstract and Introduction

Abstract

An exanthem is any eruptive skin rash that may be associated with fever or other systemic symptoms. Causes include infectious pathogens, medication reactions and, occasionally, a combination of both. In children, exanthems are most often related to infection and, of these, viral infections are the most common. Some exanthems have very specific morphologies that help identify and characterize the eruption. In this article, we describe common and uncommon viral exanthems, based on their morphology, and review current advancements in understanding and treatment of these exanthems.

Introduction

An exanthem is any eruptive skin rash that may be associated with fever or other systemic symptoms. Causes include infectious pathogens, medication reactions and, occasionally, a combination of both.

Over 100 years ago, a group of characteristic childhood eruptions were described and numbered from one to six:[1,2] measles, scarlet fever, rubella, erythema infectiosum and roseola infantum. The origin of the fourth classic childhood eruption, formerly referred to as Dukes' disease, is controversial. It may represent misdiagnosed cases of rubella or scarlet fever, rather than a distinct illness.

Viral exanthems are common in childhood. The words 'exanthema' and 'anthos' mean 'breaking out' and 'flower' in Greek, respectively. Similarly, a child breaking out with a viral exanthem may be likened to a flower bursting into bloom. In children, exanthems are most often related to infection[3] and, of these, viral infections are the most common. Determining the cause of an exanthem is based on the characteristic morphology, distribution and time course of the eruption, as well as a careful assessment of infectious contacts, immunization status and aspects of the physical examination. Although not always diagnostic, the morphology and configuration of cutaneous lesions are of considerable importance to the classification and diagnosis of viral exanthems. For the purpose of this article, we will characterize common and uncommon viral exanthems, based on their morphology, and will discuss current advancements in understanding and treatment of these viral diseases.

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