Other conditions causing maculopapular rash
Scarlet fever essentials
- Key indicators are prodromal symptoms of sore throat, then fever followed by blanching rash on torso has a sandpaper-like quality
- Symptoms should resolve in about one week
- Complications, although rare, include otitis media, sinusitis, acute rheumatic fever, glomerulonephritis, bacteraemia, pneumonia, endocarditis and meningitis.
Other conditions causing maculopapular rash
Characterised by a blanching and/or itchy rash that can appear anywhere on the body.
Drug eruptions (exanthematous)
Commonly used medicines such as antibiotics, anticonvulsants and NSAIDs are commonly associated with maculopapular rash that occurs within four to 12 days after starting the medicine. The rash usually first appears on the trunk before spreading to the limbs and neck. The distribution is bilateral and symmetrical. Lesions itch or may feel hot.
Erythema multiforme
This mostly affects children and young adults, and is characterised by symmetrical macules, papules or wheals on the tops of the hands and forearms, although other parts of the body can be affected. Onset is usually sudden in an otherwise healthy individual. Systemic symptoms vary, but malaise, pain in the joints (arthralgia), muscular stiffness and fever are frequent. Medication is known to be a trigger factor and includes anticonvulsants, antibiotics and NSAIDs.
Travellers are at risk of vector-borne diseases, some of which present with rash.
Dengue fever
This is found in tropical and sub-tropical climates, including parts of Europe. Most people are asymptomatic, but when symptoms occur, there may be high fever often accompanied by a severe headache, muscle and joint pains, nausea, vomiting, abdominal pain and anorexia. Around the third day, a maculopapular rash develops, spreading from the trunk to the face and limbs
West Nile fever
Most people are asymptomatic but those who experience symptoms may exhibit flu-like effects, vomiting, diarrhoea or rash. In a small proportion of cases it can lead to encephalitis
Zika virus
Zika virus may be symptomless, or the symptoms can be vague and mild. They last for up to a week. The most common symptoms of Zika are fever, rash, headache, conjunctivitis, joint and muscle pain.
Cutaneous lupus erythematosus
This is a rare autoimmune condition. The typical example of acute cutaneous lupus is malar rash. Sub-acute cutaneous lupus usually involves rashes on the upper limbs and trunk resembling a maculopapular rash.
Juvenile idiopathic arthritis
Juvenile idiopathic arthritis (JIA) is seen in those under 16 years of age. The main symptom is pain and swelling of several joints (arthritis). It is used to describe several disease sub-types for which signs and symptoms vary. Systemic onset juvenile chronic arthritis (Stills disease) will present with additional symptoms of fever and rash.
Kawasaki disease
This is a rare condition mainly affecting children under five years of age. In many children, the initial symptom is a high-grade fever that typically rises and falls, and lasts for more than five days. It can be confused with scarlet fever as other symptoms include swollen cervical glands, strawberry tongue and rash. However, other symptoms that can be seen are conjunctivitis, swollen and red hands and feet, and dry, red cracked lips. If untreated, approximately 25 per cent of children will develop heart complications, which can be fatal.