Table 3.
| Viral URTIs with exanthems | Cutaneous exanthem | Timing of the cutaneous manifestations |
|---|---|---|
| Measles (morbillivirus), Fig. 2 | Erythematous macules and papules that spread in a cephalocaudal direction | 2–4 days after prodrome |
| Rubella (rubella virus) | Rose‐pink macules with cephalocaudal spread | 1–5 days after prodrome |
| Erythema Infectiosum (parvovirus B19 (PVB19)) | Bright red macular erythema of the cheeks (slapped cheeks), followed by lacy reticular pattern of macules and papules on the extremities | 7–10 days after prodrome |
| Roseola Infantum (human herpesvirus (HHV) 6B and HHV‐7) | Rose‐pink macules and papules on the trunk, neck and proximal extremities | 3–4 days later |
| Unilateral laterothoracic exanthem (Epstein–Barr virus, adenovirus and PVB19, HHV‐7, parainfluenza) | Morbilliform eruption which is initially unilateral, affecting mainly the axilla and lateral trunk | Few days after the prodrome |
| Varicella (varicella‐zoster virus, VZV) | Erythematous macules and papules on the scalp and face that spread to the trunk and extremities. Lesions evolve into 1–3 mm clear vesicles that evolve into pustules and crust | 12 h after the prodrome |
| Kawasaki disease | Macular and papular erythematous lesions in a morbilliform pattern | Early in the illness |
| Pityriasis Rosea (multiple causes; HHV‐6 and HHV‐7, but can also be triggered by hepatitis C, HINI influenza, HHV‐8) | Starts with a herald patch (single oval macule) followed by a generalised maculopapular eruption | Herald patch appears 1–20 days before the generalised exanthem |
| Erythema Multiforme (parapoxvirsuses, HIV, CMV, VZV, hepatitis viruses) | ‘target‐like’ lesions, which can involve mucous membranes | Abrupt onset, within 24 h |
| Human parechoviruses (HPeV −1, 2) | Maculopapular exanthem | Skin signs appear 3 days after febrile illness |
| Togaviruses (esp. Chikungunya) and bunyavirus haemorrhagic fevers (including Lassa) | Generalised maculopapular petechial exanthem. Often pruritic and may be accompanied by oral or genital aphthous ulceration | 2–3 days after onset of fever |
| Hand, foot and mouth disease (coxsackievirus 16, 4, 5, A7, A9, A10, B2, B5 and enterovirus 71), Fig. 3 |
Oral lesions begin as erythematous macules and papules on the hard palate, tongue, cheeks and gums then progress to vesicles, which may burst and may form painful ulcers surrounded by a red halo Skin lesions start as erythematous macules or papules which quickly turn into small, grey vesicles surrounded by a red halo |
Variable timing, usually early in the illness |
| Papular pruritic gloves and socks syndrome (PVB19, EBV, CMV, HHV‐6, HHV‐7, hepatitis B, rubella, measles) | Macular and papular erythema associated with oedema affecting the hands, wrists, feet and ankles. Oral inflammation with petechiae, vesicopustules and ulceration is also common. | Onset of the eruption occurs a few days before fever and malaise |
| Toxoplasma gondii, ‘others’ including syphilis, rubella, cytomegalovirus and herpes simplex types 1 and 2 (TORCH) (‘Others’ now also includes: coxsackie, enteroviruses, PVB19, VZV, HIV, hepatitis B, Zika virus) | Purpura and petechiae associated with oral vesicles and mucosal inflammation if caused due to herpes virus | Variable onset depending on the cause |
| Zika virus (flavivirus) | Morbilliform or scarlantiniform eruption | Starts on the face on the first day and then spreads to trunk and limbs |