It's that time of year. The little ones are heading to school and inevitably exposed to much larger groups of children. With this also comes a higher risk of catching a virus or bacteria. One of the most challenging to both diagnose and treat is 'the rash', or exanthem, as commonly referred to in the healthcare field. These infections are especially common in childhood. There are many types of childhood exanthems, with viral exanthems being the most common.

Pediatric and childhood exanthems do not always fit the 'classic' picture and can often be confused with each other. That being said, they can generally be classified based on clinical features such as distribution, time course and other factors of physical examination. Let's explore the varying types of exanthems and how to spot them. 

What Are The Types of Childhood Exanthems?

There are various types of exanthems, including measles, rubella, scarlet fever, fifth disease, roseola and chicken pox. These are some of the more well-known and common skin conditions that affect children. Keep reading to learn more about these conditions. 

Measles

Measles is a highly contagious viral infection caused by the paramyxovirus. Vaccination has greatly reduced cases, but measles still occurs. Infections peak during late winter and early spring. After exposure, a two-to-four-day prodromal period beings. Early symptoms include fever, cough, runny nose, and conjunctivitis. Some people develop Koplik spots inside the cheeks, although not everyone does. A dark red or purple rash usually starts at the hairline. The rash spreads downward over three to four days. The spots temporarily turn white when pressed. Symptoms typically peak around the fourth day. The rash usually fades within one to two weeks. People can spread measles several days before the rash appears and for about four days afterward. Measles can affect people of any age.

German Measles (Rubella)

Rubella usually causes milder symptoms than measles and results from the togavirus. Adolescents experience the highest infection rates. Routine MMR vaccination has greatly reduced rubella cases. The virus spreads through respiratory secretions. People remain contagious from one week before the rash until at least one week afteward. Common symptoms include a low fever, swollen neck lymph nodes, and upper respiratory symptoms. About half of infections cause no noticeable symptoms. The rash begins as pink spots that gradually turn light brown. Unlike measles, rubella spots do not turn white when pressed. Serious complications are uncommon. However, infection during the first trimester of pregnancy can cause congenital rubella. This condition may lead to heart defects, deafness, blindness, or fetal loss.

The MMR Vaccine

The MMR vaccine is a combination vaccine developed to prevent measles, mumps and rubella (German measles). It is generally administered to children around the 1 year mark, with a second dose administered around the time that children begin school. The second dose was introduced in the late 1980's, as approx 2-5% of children were not developing immunity with just one administration. Some healthcare professionals believe vaccination is essential, given there is a lack of effective anti-viral treatment options.

There has been some controversy about the safety of combination vaccinations in general, as well as the MMR vaccine in particular, being related to autism. Perhaps because of this, over the past few years, more and more parents are choosing against vaccination or choosing to follow a delayed schedule.

Chicken Pox (Varicella)

Chickenpox is one of the most common childhood viral infections. The varicella-zoster virus can infect people of any age. A vaccine became available in 1995, but breakthrough infections still occur. Childhood infections usually remain mild, while adult infections often cause more severe symptoms. The virus spreads through respiratory secretions and direct contact with skin lesions. A mild fever and general malaise may appear two days before the rash. Itchy spots usually begin on the face and scalp. The rash then spreads to the trunk and limbs. Lesions progress from bumps to blisters before crusting over. Different stages of the rash often appear simultaneously. Most lesions heal within one to two weeks. People remain contagious until every lesion has crusted. Later reactivation can cause shingles. Pregnancy-related complications are rare but can seriously affect the fetus.

Erythema Infectiosum (Fifth Disease, or Slapped Cheek Disease)

Slapped cheek disease causes a bright red facial rash, usually on the cheeks. Children aged four to ten most often develop infection in winter and spring. Parvoirus B19 causes erythema infectiosum. The virus spreads through respiratory droplets, and many children develop immunity after exposure. A contagious prodromal phase may begin with mild fever, runny nose, and headache. A red facial rash then appears, often sparing the nose bridge and eye area. Once the rash appears, the person is no longer contagious. Some children later develop a lace rash on the trunk and limbs. This secondary rash can last up to six weeks and may cause mild itching. Most cases remain mild in children, with occasional joint pain. Pregnancy requires caution due to fetal risks. Infection during early pregnancy may cause fetal anemia, hydros fetalis, or fetal loss.

Scarlet Fever

Children aged two to ten face the highest risk of scarlet fever infection. Streptococcus pyogenes causes scarlet fever, unlike most viral exanthems. Children often develop sore throat, tonsilities, and pharyngitis before the rash appears. The prodromal phase varies in duration between individuals. A pinpoint rash then develops, starting on the trunk and sometimes the face. The rash spreads outward to the extremities. This pattern helps distinguish scarlet fever from rubella and measles. Redness often intensifies in skin folds and around the neck. Fever, headache, and sometimes vomiting often accompany the rash. A strawberry tongue appears with red, enlarged papillae. A white coating may partially cover the tongue. Symptoms and rash usually resolve within five to seven days. Antiobiotics effectively treat scarlet fever. Early treatment reduces the risk of complications such as rheumatic fever, kidney inflammation, ear infection, myocarditis, mastoiditis, and pneumonia.

Roseola Infantum

Roseola Infantum affects the youngest group thus far, with peak incidence at 6-7 months of age and most commonly occurring in children less than 36 months. The human herpes virus 6 or 7 is responsible. Again, the virus is spread through saliva and respiratory secretions. Unlike some of the other infections mentioned here, the virus remains dormant initially following infection; it then has the potential to reactivate when the immune system is compromised. Roseola has no prodrome. The first presenting symptom is a sudden high fever, which usually lasts about four days. The fever may be accompanied by vomiting, diarrhea and some lymphadenopathy. In about 30% of the cases, a rash will erupt once the fever has subsided. The rose coloured lesions spread outwards, starting on the trunk. The rash is transient and may last only a few hours to a few days. Due to very high fever and the younger age of this population, Roseola infantum can be associated with febrile seizures.

What Are Natural Treatment Options for Different Types of Childhood Exanthems?

In terms of natural treatments, keep in mind that most of these infections simply need to run their course. That being said, there are some anti-virals that may speed-up the resolution of the systemic symptoms associated with the virus, such as headache, nausea, vomiting, fever, etc. 

Elderberry and Olive leaf extract, either in combination or used separately, both have effective anti-viral properties. They have all been shown to slow or prevent the varicella virus from replicating. Olive leaf is also anti-bacterial, meaning it will also be effective against Scarlet Fever. Echinacea has also been shown to be helpful in many of these infections. 

Aloe vera gel can be applied topically to soothe the lesions associated with any of the above. It is healing (anti-inflammatory) and soothing, decreasing itch and speeding resolution. Colloidal silver can also be found in spray form and can be used to treat external eruptions associated with these viral and bacterial infections. An oat bath can also help to soothe the itch and heal lesions. Put 1/2 cup to 1 cup of oats in a cheese cloth (I also use old panty hose), tie it tightly and put it right in the bath water with you, squeezing from time to time. Make sure to keep the bath warm, but not too hot, as hot water will further dry out the skin. 

Decrease intake of refined sugar and increase vegetable and fruit intake. It’s also important to stay hydrated. Soups are an excellent veggie-rich meal that also helps to hydrate, as are electrolyte replacement drinks to prevent dehydration.