From the Guidelines
Viral exanthems are characterized by widespread eruptions that often follow a predictable pattern, with common examples including measles, rubella, roseola, erythema infectiosum, varicella, and hand-foot-mouth disease, typically presenting with fever followed by distinctive rash patterns. These conditions can be caused by various viruses, including herpesviruses such as varicella-zoster virus (VZV) 1. The management of viral exanthems is primarily supportive, focusing on symptom relief with medications such as acetaminophen or ibuprofen for fever and discomfort.
Characteristics of Viral Exanthems
- Common viral exanthems include:
- Measles (rubeola)
- Rubella
- Roseola
- Erythema infectiosum (fifth disease)
- Varicella (chickenpox)
- Hand-foot-mouth disease
- These conditions typically present with fever followed by distinctive rash patterns, such as:
- Measles: a red, blotchy rash starting on the face
- Rubella: a fine pink rash
- Roseola: a rash appearing after fever resolves
- Fifth disease: a "slapped cheek" appearance
- Chickenpox: pruritic vesicles
- Hand-foot-mouth disease: vesicles in the mouth and extremities
Management of Viral Exanthems
- Management is primarily supportive, focusing on symptom relief with:
- Acetaminophen or ibuprofen for fever and discomfort
- Antihistamines like diphenhydramine for itching
- Maintaining hydration is essential, especially with painful oral lesions
- Specific antiviral medications are rarely indicated except for severe cases, such as:
- Acyclovir for severe varicella in immunocompromised patients (20 mg/kg IV every 8 hours for 7-10 days) 1
- Isolation measures should be implemented to prevent transmission, particularly for highly contagious conditions like measles and chickenpox
- Vaccination remains the most effective prevention strategy for many viral exanthems, including measles, rubella, and varicella 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Characteristics of Viral Exanthems
- Viral exanthems can present with diverse morphologies of rash, including macular, maculopapular, papular, urticarial, and vesicular, or sometimes a combination of these 2
- They can be classified as erythematous, vesicular, and papular, with the majority being erythematous 3
- The most common viral causes include non-polio enteroviruses, respiratory viruses, acute Epstein-Barr virus, human herpes viruses 6 and 7, and parvovirus B-19 3
- Fever and rash are common manifestations of viral exanthems, collectively known as febrile exanthem 4
Management of Viral Exanthems
- Although final diagnosis often relies on serological and molecular tests, certain cutaneous clues can help arrive at a probable clinical diagnosis 2
- The clinical diagnosis of viral exanthems can be based on age, distribution, and morphology of the rash, as well as associated symptoms 5
- Diagnostic considerations include differential diagnoses according to age groups, distribution and morphology of the rash, and diagnostic tests if applicable 5
- A general approach to the patient with a possible viral exanthem involves discussing several current issues germane to "classic" exanthems and delving into greater detail regarding atypical presentations 6
Clinical Features and Diagnosis
- Patients with viral exanthems commonly present to general practitioners, and most can be distinguished initially on the basis of age, distribution, and morphology of the rash without requiring investigations 5
- Certain exanthems can be considered depending on the age of the patient, and most can be distinguished by the distribution and morphology of the rash 5
- Striking findings involving the integumentary system, such as Koplik's spots and generalized maculopapular rash, can facilitate clinical diagnosis 4