From the Guidelines
The most common maculopapular viral exanthems on the face include human herpesvirus 6 infection (i.e., roseola), human parvovirus B19, enteroviral infection, and Epstein-Barr virus infection. These conditions can present with a range of symptoms, including fever, rash, and systemic signs, making diagnosis and management challenging 1.
Key Characteristics of Each Condition
- Human herpesvirus 6 infection (roseola) is characterized by high fever for several days followed by a blanching maculopapular rash that appears as the fever resolves.
- Human parvovirus B19 (erythema infectiosum or fifth disease) features the distinctive "slapped cheek" appearance with bright red cheeks and a lacy reticular rash on the extremities.
- Enteroviral infections can cause a variety of rashes, including maculopapular and petechial rashes, often accompanied by fever and systemic signs.
- Epstein-Barr virus infection (infectious mononucleosis) can present with a rash, fever, lymphadenopathy, and fatigue.
Management and Treatment
Treatment for these conditions is generally symptomatic, with antipyretics like acetaminophen or ibuprofen used to manage fever and discomfort 1. It is essential to maintain adequate hydration in all patients with viral exanthems. Isolation measures may be necessary for certain conditions to prevent transmission.
Differential Diagnosis
The differential diagnosis for maculopapular rashes is broad and includes various viral, bacterial, and other infections, as well as drug reactions and immune complex-mediated illnesses 1. A thorough clinical evaluation, including the rash's characteristics, distribution, and progression, as well as other systemic signs and symptoms, is crucial for making an accurate diagnosis.
From the Research
Maculopapular Viral Exanthems on the Face
- The most common maculopapular viral exanthems on the face include measles, rubella, and mumps 2, 3.
- These viral infections can cause a range of symptoms, including fever, rash, and respiratory issues 2.
- The diagnosis of maculopapular viral exanthems can be challenging due to overlapping clinical features with drug-induced exanthems 4, 5.
- Histopathological evaluation of skin biopsies can help differentiate between viral and drug-induced exanthems, with features such as lymphocytic exocytosis and dermal infiltrate of eosinophils, lymphocytes, and histiocytes being more common in drug exanthems 4, 5.
Common Viral Exanthems
- Measles is a highly contagious viral infection that can cause a maculopapular rash on the face and body 2, 3.
- Rubella is another viral infection that can cause a maculopapular rash, as well as fever and lymphadenopathy 2.
- Mumps is a viral infection that can cause a range of symptoms, including parotid gland swelling and a maculopapular rash 2.
Diagnosis and Prevention
- The diagnosis of maculopapular viral exanthems is often based on clinical presentation and laboratory tests, such as serum C-reactive protein and absolute eosinophil count 4.
- Prevention of measles, rubella, and mumps can be achieved through vaccination, with the measles-mumps-rubella (MMR) vaccine being recommended for children and adults at high risk of exposure 2, 3.