Exanthema in children: causes, clinical picture, treatment, prevention

General information

Exanthema (rash) is a reaction of the skin and mucous membranes (in this case we speak of enanthema) to the action of microbes or viruses.
It has different shapes, sizes and accompanies many diseases. Currently, infectious exanthemas (or another name - viral exanthemas) are combined into a group of viral infections, which at a certain stage manifest themselves as a rash. The infectious nature is supported by an acute onset, intoxication, temperature, the cyclical nature of the process, and the presence of characteristic signs for a particular infectious disease.

The difficulty is that for correct diagnosis, and therefore treatment, it is important to know the differential signs of exanthema that distinguish one disease from another. If measles, rubella, infectious mononucleosis, chickenpox are accompanied by exanthema as an obligatory component of the clinical picture of this disease, then with other viral infections the rash is unstable and changeable. Therefore, these infections often remain unrecognized, and the appearance of a rash is regarded as a manifestation of urticaria , atopic dermatitis or an allergic reaction to medications.

Viral exanthema on the body indicates the systemic spread of the pathogen. An important sign is that the viral rash is rarely localized to the palms and plantar surfaces (with the exception of some infections). Exanthema often coexists with enanthema (rash on the mucous membrane), with the latter appearing 1-2 days earlier. Some signs of viral replication in the mucous membranes of the mouth help in making a diagnosis. With herpangina (an infection caused by the Coxsackie A virus), ulcers appear on the mucous membrane of the tonsil arches and uvula, with measles - Koplik-Filatov spots, and petechiae on the palate with infectious mononucleosis. Even with careful examination, about 50% of infectious exanthems remain unspecified.

Pathogenesis

The following pathogenetic mechanisms are distinguished in the development of viral exanthema:

• Various viruses enter the skin through the bloodstream and cause tissue damage.
• Activation of the body's immune defense factors.
• Interaction of pathogens with immune factors (humoral and cellular) and the production of pro-inflammatory cytokines . This mechanism causes the rash to appear.
• Viremia stimulates the formation of neutralizing antibodies (IgM), which ultimately leads to its cessation.

The basis for the appearance of any rash is inflammation. The virus has an initial effect on the blood vessels of the skin, the damage of which is manifested by hyperemia . Then an inflammatory reaction develops around the vessels in the form of erythema . More pronounced inflammation is manifested by various exudative rashes. In some cases, circulating immune factors themselves, without the presence of pathogens, can cause rashes ( purpura fulminans , acute urticaria , Stephen Jones syndrome ).

Epidemiology

Viral infections with exanthema are caused by various viruses and some of them are precisely defined:

• The sixth disease is associated with herpes viruses types 6 and 7. It manifests itself as roseola in children, and in adults as chronic fatigue syndrome, which is associated with the persistence of the virus. It occurs in children under 3 years of age, with a peak incidence from 7 to 13 months. Most children are seropositive at birth (that is, they have maternal antibodies), but their titer decreases by 5 months. Type 6 HHV is characterized by the ability to persist and remain in the infected person’s body in a latent state without manifestation of the disease. Some scientists associate multiple sclerosis , pityriasis rosea , and thrombocytopenic purpura , but such statements are controversial.
• measles virus causes the corresponding disease.
• Parvovirus B19 - Chamer's erythema or burning cheeks disease. Itching with this disease is moderate.
• Boston exanthema is an infection caused by the ECHO 9.16 virus, less commonly by Coxsackie virus. For the first time in 1951 in Boston during an epidemic, the causative agent of this infection was described and studied.
• Coxsackieviruses A and B and ECHO are associated with hand-foot-mouth disease.
• Other enteroviral exanthemas are associated with infection with Coxsackie viruses A10, A16 and enterovirus type 71.

The source of infection is the patient and the virus carrier (for enterovirus infection). The patient sheds the measles virus during the last 2 days of the incubation period until the 4th day of the rash. Individuals who have not been vaccinated and have not had measles are highly susceptible to the virus and can become ill during their lifetime at any age. The same applies to enterovirus infections, which are caused by different serotypes of viruses, then immunity is developed only to a given serotype of the virus (type-specific). This means that the next time a person may become ill with an enterovirus infection caused by another type of virus currently circulating in nature. A person who has been ill sheds the virus in their stool for several weeks.

Virus infection occurs in various ways:

• Airborne. Characteristic of the sixth disease, measles, rubella. In the sixth disease, the virus infects the salivary glands and is released along with saliva. The gateway to infection in the case of airborne transmission is the mucous membrane of the respiratory tract. In the mucosal epithelium, the virus multiplies, spreads hematogenously and becomes fixed in organs. From the last days of incubation and the first days of the appearance of the rash, the virus is released from the blood, so transmission of infection (including the sixth disease) is possible through blood obtained from the patient during this period.
• Fecal-oral - more typical for enteroviruses that cause Boston exanthema, hand-foot-mouth disease. Enteroviruses are ubiquitous and remain in the environment for a long time (water, soil, household items, food) because they are resistant to chemical and thermal factors. They penetrate the mucous membrane of the gastrointestinal tract, multiply in the lymph nodes, and after 2-3 days they enter the blood ( viremia ) - this is the period that is accompanied by the appearance of a rash. For these infections, an airborne transmission mechanism cannot be ruled out.
• The incubation time for infections is different: for enterovirus infections it is 3–8 days, for measles it is slightly longer – 6–21 days, for rubella – 16–20 days. All infections are characterized by an acute onset, fever , sore throat, muscle pain and diarrhea (for some diseases).

Memo for parents on viral diseases

Memo for parents.

Measles is a viral infection characterized by very high susceptibility. If a person has not had measles or has not been vaccinated against this infection, then after contact with a sick person, infection occurs in almost 100% of cases. The measles virus is very volatile. The virus can spread through ventilation pipes and elevator shafts - children living on different floors of the house become ill at the same time.

The period from contact with a person with measles to the appearance of the first signs of the disease lasts from 7 to 14 days.

The disease begins with severe headache, weakness, and fever up to 40 degrees C. A little later, these symptoms are joined by a runny nose, cough and an almost complete lack of appetite.

Very characteristic of measles is the appearance of conjunctivitis - inflammation of the mucous membrane of the eyes, which is manifested by photophobia, lacrimation, severe redness of the eyes, and subsequently the appearance of purulent discharge. These symptoms last for 2 to 4 days.

On the 4th day of the disease, a rash appears , which looks like small red spots of various sizes (from 1 to 3 mm in diameter), with a tendency to merge. The rash appears on the face and head (it is especially typical behind the ears) and spreads throughout the body over 3 to 4 days. What is very characteristic of measles is that the rash leaves behind pigmentation (dark spots that last for several days), which disappears in the same sequence as the rash appears.

When contracting measles, quite serious complications can occur . These include pneumonia (pneumonia), inflammation of the middle ear (otitis media), and sometimes such a serious complication as encephalitis (inflammation of the brain).

It must be remembered that after suffering from measles for a fairly long period of time (up to 2 months), there is suppression of the immune system, so the child may get sick with some kind of cold or viral disease, so you need to protect him from excessive stress, and, if possible, from contact with sick children.

After measles, lasting lifelong immunity develops. All those who have had measles become immune to this infection.

The only reliable protection against the disease is vaccination against measles, which is included in the National Vaccination Calendar.

Memo for parents.

Rubella is a viral infection spread by airborne droplets. As a rule, children who stay in water for a long time with a child who is a source of infection get sick. Rubella is very similar in its manifestations to measles, but it is much milder.

The period from contact to the appearance of the first signs of the disease lasts from 14 to 21 days.

Rubella begins with an enlargement of the occipital lymph nodes and an increase in body temperature to 38 degrees C. A little later, a runny nose and sometimes a cough develop. A rash appears 2–3 days after the onset of the disease. Rubella is characterized by a pinpoint pink rash that begins as a rash on the face and spreads throughout the body. The rash with rubella, unlike measles, never merges, and slight itching may occur. The period of rash can be from several hours, during which not a trace remains of the rash, to 2 days.

Treatment of rubella consists of alleviating the main symptoms - fighting fever, if present, treating a runny nose, expectorants.

Complications from rubella are rare.

After suffering from rubella, immunity also develops; re-infection is extremely rare, but can occur.

Therefore, it is very important to receive the rubella vaccine, which, like the measles vaccine, is included in the National Vaccination Calendar.

Memo for parents.

Mumps (mumps) is a childhood viral infection characterized by acute inflammation in the salivary glands.

Infection occurs by airborne droplets. Susceptibility to this disease is about 50-60% (that is, 50-60% of those who were in contact and were not sick and not vaccinated get sick).

From the moment of contact with a patient with mumps until the onset of the disease, 11–23 days can pass.

Mumps begins with an increase in body temperature to 39 degrees C and severe pain in the ear area or under it, aggravated by swallowing or chewing. At the same time, salivation increases. Swelling in the upper neck and cheek area increases quite quickly; touching this area causes severe pain in the child. Unpleasant symptoms disappear within three to four days: body temperature decreases, swelling decreases, pain goes away.

However, quite often mumps ends with inflammation in glandular organs , such as the pancreas (pancreatitis) and gonads. Pancreatitis in some cases leads to diabetes mellitus . Inflammation of the gonads (testicles) occurs more often in boys. This significantly complicates the course of the disease, and in some cases can result in infertility. In particularly severe cases, mumps can be complicated by viral meningitis (inflammation of the meninges), which is severe.

After an illness, a strong immunity is formed, but complications can lead to disability.

The only reliable protection against the disease is vaccination against mumps, which is included in the National Vaccination Calendar.

Memo for parents.

Varicella (chickenpox) is a typical childhood infection. Mostly young children or preschoolers are affected. Susceptibility to the causative agent of chickenpox (the virus that causes chickenpox is a herpes virus) is also quite high. About 80% of contacts who have not previously been ill develop chickenpox.

From the moment of contact with a patient with chickenpox until the first signs of the disease appear, 14 to 21 days pass.

The disease begins with the appearance of a rash. Usually it is one or two reddish spots that look like a mosquito bite. These rash elements can be located on any part of the body, but most often they first appear on the stomach or face. Usually the rash spreads very quickly - new elements appear every few minutes or hours. Reddish spots, which at first look like mosquito bites, the next day take on the appearance of bubbles filled with transparent contents. These blisters are very itchy. The rash spreads throughout the body, to the limbs, and to the scalp. In severe cases, elements of the rash are also present on the mucous membranes - in the mouth, nose, scleral conjunctiva, genitals, and intestines. By the end of the first day of the disease, general health worsens, body temperature rises (up to 40 degrees C and above). The severity of the condition depends on the number of rashes. If elements of the rash are present on the mucous membranes of the pharynx, nose and on the conjunctiva of the sclera, then pharyngitis, rhinitis and conjunctivitis develop due to the addition of a bacterial infection. The blisters break open after a day or two, forming ulcers that become crusty. Headache, poor health, and fever persist until new rashes appear. This usually occurs within 3 to 5 days. Within 5-7 days after the last additions, the rash goes away.

Treatment of chickenpox consists of reducing itching, intoxication and preventing bacterial complications. The elements of the rash must be lubricated with antiseptic solutions (usually an aqueous solution of brilliant green or manganese). Treatment with coloring antiseptics prevents bacterial infection of rashes and allows you to track the dynamics of the appearance of rashes. It is necessary to monitor the hygiene of the oral cavity and nose, eyes - you can rinse your mouth with a solution of calendula, the mucous membranes of the nose and mouth also need to be treated with antiseptic solutions.

Complications of chickenpox include myocarditis - inflammation of the heart muscle, meningitis and meningoencephalitis (inflammation of the meninges, the substance of the brain), inflammation of the kidneys (nephritis). Fortunately, these complications are quite rare. After chickenpox, as well as after all childhood infections, immunity develops. Re-infection does occur, but is very rare.

Memo for parents.

Scarlet fever is the only childhood infection caused not by viruses, but by bacteria (group A streptococcus). This is an acute disease transmitted by airborne droplets. Infection through household items (toys, dishes) is also possible. Children of early and preschool age are sick. Patients are most at risk for infection in the first two to three days of the disease.

Scarlet fever begins very acutely with an increase in body temperature to 39 degrees C, vomiting, and headache. The most characteristic symptom of scarlet fever is tonsillitis , in which the mucous membrane of the pharynx is bright red and swelling is pronounced. The patient notes a sharp pain when swallowing. There may be a whitish coating on the tongue and tonsils. The tongue subsequently takes on a very characteristic appearance ( “crimson ”)—bright pink and coarsely grained.

the second characteristic symptom of scarlet fever appears It appears on several parts of the body at once, most densely located in the folds (elbow, inguinal). Its distinctive feature is that the bright red pinpoint scarlet rash is located on a red background, which creates the impression of a general confluent redness. a white stripe remains . The rash can be spread over the entire body, but the area of ​​skin between the upper lip and nose, as well as the chin, clear The itching is much less pronounced than with chickenpox.

The rash lasts up to 2 to 5 days. Manifestations of sore throat persist somewhat longer (up to 7–9 days).

Treatment of scarlet fever is usually carried out with the use of antibiotics , since the causative agent of scarlet fever is a microbe that can be removed with the help of antibiotics and strict adherence to bed rest . Local treatment of sore throat and detoxification (removal of toxins from the body that are formed during the life of microorganisms - for this purpose, give plenty of fluids) are also very important. Vitamins and antipyretics are indicated. Scarlet fever also has quite serious complications . Before the use of antibiotics, scarlet fever often resulted in the development of rheumatism with the formation of acquired heart defects or kidney diseases. Currently, provided that treatment is properly prescribed and recommendations are carefully followed, such complications are rare.

Scarlet fever affects almost exclusively children because with age a person acquires resistance to streptococci. Those who have recovered also acquire lasting immunity.

Memo for parents.

Whooping cough is an acute infectious disease characterized by a long course. A distinctive sign of the disease is a spasmodic cough.

The mechanism of transmission of infection is airborne droplets. A feature of whooping cough is the high susceptibility of children to it, starting from the first days of life.

From the moment of contact with a person with whooping cough until the first signs of the disease appear, 3 to 15 days pass. A feature of whooping cough is a gradual increase in cough over 2 to 3 weeks after its onset.

Typical signs of whooping cough:

• · persistent, intensifying cough, gradually turning into attacks of spasmodic cough (a series of coughing impulses, quickly following each other on one exhalation) with a convulsive inhalation, accompanied by a lingering whistling sound. In infants, such a cough can lead to respiratory arrest. Coughing attacks worsen at night and end with the release of a small amount of viscous sputum, sometimes with vomiting;
• Puffiness of the face, hemorrhages in the sclera;
• · an ulcer on the frenulum of the tongue (due to its injury from the edges of the teeth, since during a coughing attack the tongue protrudes outward to the limit, its tip bends upward).

Whooping cough is often complicated by bronchitis, otitis media, pneumonia, rectal prolapse, umbilical and inguinal hernias.

After suffering from whooping cough for a long time (several months), coughing attacks may return, especially if the child has a cold or during physical exertion.

The only reliable prevention against whooping cough is vaccination with DPT, a vaccine that is included in the National Vaccination Schedule. Parents' fears about the threat of harmful effects from the vaccine are unfounded. The quality of DTP vaccine is not inferior in its properties to vaccines produced in other countries.

Memo for parents.

Acute intestinal infections are a large group of diseases that occur with more or less similar symptoms, but can be caused by a huge number of pathogens: bacteria, viruses, protozoan microorganisms.

In summer, the number of intestinal infections in children inevitably increases. There are several reasons for this.

Firstly , in the summer, a large number of raw vegetables, fruits and berries are eaten, on the unwashed surface of which a huge number of microbes live, including potentially dangerous ones.

Secondly , in the summer, children spend a lot of time outside, and even their parents do not always remember that eating with clean hands is a mandatory rule .

Third reason : in the summer, when they get into food products (dairy products, meat, fish, broths), some pathogenic microorganisms multiply at enormous speed and quickly reach an amount that successfully breaks through the protective barriers of the gastrointestinal tract.

From the moment the pathogen enters the gastrointestinal tract until the onset of the disease, it can take from several hours to 7 days.

The disease begins with an increase in body temperature, malaise, weakness, and lethargy. Appetite is sharply reduced, nausea and vomiting quickly follow. The stool is loose and frequent with impurities. The consequence of fluid loss is dry mucous membranes and skin, facial features become sharper, the child loses weight, and urinates little. The facial expression is pained. If your child shows any of the above signs of illness, call a doctor immediately. Self-medication is unacceptable .

Prevention of intestinal infections requires strict adherence to general hygiene measures in everyday life, when preparing food and while eating.

In summer, all food products should be covered from flies. Prepared food should be stored in the refrigerator: at low temperatures, even if microbes get into the food, they will not be able to multiply. The disease can also be caused by indiscriminate purchasing of food products that are eaten without heat treatment - from hand, outside markets, where they do not undergo sanitary control. When swimming in open waters, under no circumstances should you allow yourself to swallow water. If you eat on the beach, wipe your hands with at least special wet wipes.

And remember that the personal example of parents is the best way to teach a child.

Memo for parents.

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis human, which primarily affects the respiratory system, as well as all organs and systems of the body.

The source of infection is people with tuberculosis. The most common route of infection is airborne. Transmission factors include nasopharyngeal mucus, sputum and dust containing bacteria.

The proliferation of tuberculosis bacteria in a child’s body leads to significant functional disorders with symptoms of intoxication: irritability or, conversely, lethargy, fatigue, headache, sweating. Body temperature rises to 37.2 - 37.3o, sleep and appetite are disturbed. With a long course of the disease, the child loses weight, the skin becomes pale, and there is a tendency to inflammatory diseases. For children, the reaction from the lymph nodes is typical: they increase in size and become dense. If left untreated, the disease may progress to more severe forms.

For the diagnosis of tuberculosis intoxication, it is important to determine infection using tuberculin tests , and for children over 12 years old - also using fluorography.

To prevent tuberculosis, it is very important : to lead a healthy lifestyle, strictly observe sanitary and hygienic rules: wash your hands before eating, do not eat unwashed vegetables and fruits, as well as dairy products that have not passed sanitary control, eat well, exercise, pay attention to changes in health status.

An important point for the prevention of tuberculosis is the annual Mantoux test, which gives a positive result when pathogenic bacteria penetrate the child’s body.

Classification

There is no unified classification of diseases occurring with exanthema. Conventionally, diseases are distinguished in which:

• Rashes are always present ( chicken pox , fever , measles ).
• A rash is not an obligatory symptom, but is noted ( pseudotuberculosis , herpes zoster , enterovirus infection , infectious mononucleosis , typhoid paratyphoid infections ).
• Rashes are possible, but rare (cytomegalovirus and mycoplasma infections).

According to the nature of the spread of the rash:

• Generalized.
• Localized: caused by direct exposure of the virus to the skin; associated with parainfectious process in the skin.

Rashes in infectious diseases are heterogeneous and vary in nature. If we talk about the morphology of the rash, then its primary elements (they appear on intact skin) are divided into:

• cavityless;
• cavitary.

Cavity-free include a spot, papule, nodule, tubercle, and blister. Cavity formations are considered to be a vesicle (vesicle), vesicle and pustule.

The spot has different sizes, it is irregular in shape and does not protrude above the skin. Formed when skin blood vessels dilate. Color varies from pale pink to red. When pressed, it disappears and appears again. If the spot is 1-5 mm in size, small punctate, it is classified as roseola (occurs in scarlet fever , enterovirus and sudden enanthema ). A small-spotted rash measures 5-10 mm (characteristic of rubella, infantile roseola and enteroviral exanthema), a large-spotted rash measures 10-20 mm (occurs with measles), and erythema is a spot larger than 20 mm that merges with others. Hemorrhagic spots ( petechiae ) are found in enterovirus , parvovirus B19 and Epstein–Barr infections.

Papule is a rash that rises above the skin. It is formed with deeper damage to the skin: the involvement of blood vessels and the upper layers of the dermis. Papules can leave a mark in the form of pigmentation and peeling. Papules are often combined with roseola and spots; in such cases, a roseolous-papular rash (up to 5 mm) and maculopapular (up to 20 mm) are described. Papules may be a stage of development of other elements of the rash.

A vesicle (vesicle) is a cavity formation filled with serous or hemorrhagic contents. It develops in the thickness of the epidermis. The contents of the bubble are opened with the formation of a crust (transparent or brown). Vesicles do not leave scars after resolution. This type of rash is characteristic of herpes , chickenpox , and herpes zoster . If leukocytes accumulate in large quantities in the contents of the vesicles, the contents become purulent. Vesicles of pus are called pustules and are characteristic of bacterial infections.

The bubble measures up to 15 mm or more.

Rash in a child: infectious

Most often, rashes in infectious diseases are accompanied by additional symptoms characteristic of a particular disease. As a rule, an infectious condition begins acutely, with an increase in temperature and general malaise. The epidemiological history is important, for example, there is an indication that there is a quarantine in kindergarten or school due to a certain disease. This information must be reported to the doctor.

There are infections that are very contagious, for example, chicken pox , when encountered, a person without immunity to this virus will definitely get sick. With chickenpox, the rash appears on an unchanged skin background, first in the form of bright spots, then these spots transform into blisters and then into crusts. After the crusts are rejected, traces remain on the skin in the form of small, delicate scars. Some deep scars last a lifetime and can tell the doctor that the person has had chickenpox.

Another childhood infection that occurs with a rash is scarlet fever. It is not as contagious as chickenpox, but is also transmitted by airborne droplets. It is caused by the bacterium -b hemolytic streptococcus of group A. With this infection, the rash is small-pointed, red, on a red background of the skin, with thickening in the lower abdomen, in the collar area, in natural folds.

The child's face is characteristic: bright red cheeks, with a prominent light, rash-free, nasolabial triangle. Scarlet fever is accompanied by high fever, headache, severe sore throat (the child cannot even swallow water). Purulent deposits may appear on the tonsils. If you look into the mouth, you can see a “flaming” pharynx and a special, “crimson” tongue, covered with a thick white coating, through which the red papillae of the tongue protrude. With this infection, it is very important to prescribe antibiotics promptly and correctly to avoid complications. Therefore, you can’t delay, but immediately invite a doctor to your home.

Another infectious disease is measles. Currently, it occurs rarely, in the form of outbreaks, only when imported from countries unaffected by measles and only in unvaccinated people.

The disease begins with catarrhal symptoms - runny nose, cough, lacrimation and fever. Then a rash appears in the form of dark red spots and papules, prone to fusion. The rash appears in stages (from top to bottom). Then the rash disappears in the same sequence as it appeared, leaving a brownish pigmentation on the skin that lasts 7-10 days and then disappears. With the cortex, very serious complications are possible - pneumonia, encephalitis leading to disability or death, noma (gangrene of the soft tissues of the face). Therefore, it is so important to protect yourself and your child from this serious infection. Vaccination is available for both children and adults.

Rubella, like measles, is practically never encountered at present, since in our country compulsory vaccination is carried out for children aged 1 year and 6 years. But if a child is not vaccinated, then he, of course, can get sick if he comes into contact with an imported infection. This disease is usually mild. The rash, just like with measles, is maculopapular, but pale pink, not so bright. It is not prone to merging, although due to the abundance of rashes, a solid pink background can be created. On the third day, the rash usually turns pale and disappears without a trace. Enlarged cervical lymph nodes are characteristic. Usually the disease occurs without complications, but it is very dangerous for the fetus. Congenital rubella is a disease that leads to severe disability or death of a child.

Currently, enterovirus infections are very common, causing various rashes. There may be a maculopapular rash, as with measles, and a finely spotted rash, as with rubella, and with blisters, as with chickenpox. In this case, rashes can also appear on the mucous membranes of the oral cavity. It happens that even an experienced doctor finds it difficult to deal with such rashes.

In general, with many viral diseases a rash may appear. For example, with influenza, adenovirus, and coronavirus infections, a rash also occurs. She, as a rule, does not talk about the severity or the special form of the disease. It’s just that this person’s blood vessels react this way to viral toxins.

And it is also worth mentioning a particularly severe infection, which can also occur with a rash. We are talking about meningococcal infection . Here a serious condition develops suddenly. The temperature rises sharply, the child may become lethargic and adynamic. Severe headache, possibly vomiting. And if, in addition to all this, hemorrhagic elements of the rash appear on the skin, even if there are only a few of them, then you need to urgently call an ambulance, or better yet, a resuscitation team. Such a rash indicates the development of meningococcemia (the microbe enters the circulatory system), in which mortality is very high and the outcome depends on the timely initiation of therapy. It is important to examine the entire child with a fever, and first of all the legs. If a child lies in bed in socks or pants and the mother does not see this ominous symptom in time, time may be lost.

Well, in addition to the above, various skin infections appear with various rashes .

The skin is the body's most important defense mechanism against a huge number of pathogens. But under some unfavorable conditions, this protection is not effective enough and inflammation caused by bacteria, fungi, or viruses may develop in the skin. With bacterial infections of the skin, pyoderma occurs, and then pustules and crusts appear on the skin. Some viral skin infections appear in the form of nodules and papules (for example, molluscum contagiosum, warts, papillomas are skin diseases caused by certain viruses). Fungal infections are manifested by areas of skin redness and peeling. Most often, a dermatologist diagnoses and treats skin infections.

Well, let’s summarize once again how parents should behave if they notice a rash on their child.

The first step is to assess the general condition.

1. If the child feels well, plays, has maintained his appetite, and the rash either does not bother him or it itches, then it is probably an allergic rash. We make an appointment with a doctor, having analyzed in advance the possible causes of the rash (what was new in the diet, in everyday life, etc.), so as not to miss anything when talking with the doctor.
2. If a child, along with some kind of rash, has a runny nose, cough, moderate fever, sore throat, i.e., signs of infection, we call a doctor at home.
3. If the temperature is high and there is any rash, especially hemorrhagic, immediately call an ambulance team!

about the author

• Dobrelya Ekaterina Alexandrovna
• Pediatrician, infectious disease specialist of the highest category. Head of outpatient department No. 2
• All publications by the author

Causes

The cause of infection is infection with various viruses. In itself, exposure to cold and the condition of the upper respiratory tract (for example, adenoids or enlarged tonsils in a child) do not lead to viral infections - contact with viruses is important. In a closed community (kindergarten school), one virus is responsible for the jump in incidence.

The Enterovirus genus includes 104 types of virus, but not all of them cause rash. Such a number of serotypes does not make it possible to carry out specific prevention - vaccines have not been developed. Over the course of a person’s entire life, they may be ill with an enterovirus infection several times, which may occur with or without a rash. Infection with herpes virus type 6 is associated with the development of the sixth disease (sudden exanthema). Herpes virus type 6 (HHV6) is detected in 80% of children with exanthema and is of particular epidemiological significance for children under one year of age.

According to statistics, the most common cause of exanthema in children under 3 years of age is enterovirus and parvovirus infections, which are often detected by serological and PCR studies. Measles and rubella are less common at the moment , which is due to high vaccination coverage. In summer and autumn, exanthemas can be caused by enteroviruses, and regardless of the time of year, the rash is caused by herpes viruses 6 , parvovirus B-19 , and Epstein-Barr .

Diagnostics

Is it easy to diagnose exanthema in children? The signs are typical, but the diagnosis is made in a timely manner quite rarely. While the examination is being carried out, the symptoms of the infection may disappear on their own, without medical intervention. However, even if the child’s condition improves, he must be carefully examined.

A thorough examination of the elements of the rash is necessary. These are small pink spots and papules with a diameter of up to 1-5 mm. Elements of the rash rise slightly above the surface of the skin.

Instrumental methods are used in case of complications of exanthema:

• electroencephalography;
• electrocardiography;
• ultrasound examination of the abdominal organs and some others.

Laboratory diagnosis of exanthema includes the following methods:

• general blood test - a decrease in the number of leukocytes and eosinophils is noted;
• cultural method (seeding) – it is used to identify the active virus in the child’s body;
• enzyme immunoassay of blood - immunoglobulins IgG and IgM to HHV-6 and HHV-7 are detected in the blood.

Symptoms

Viral exanthema in children is more often of the macular (spotty) or maculopapular (spot-papular) form. A small rash (fine-spotted, roseolous) occurs with sudden and Boston exanthema. Vesicular with serous exudate - in case of hand-foot-mouth disease. The disease in children under three years of age is milder than in older children and adolescents. There may be variants that manifest only as a rash with fever, but without signs specific to this infection.

Exanthems caused by enteroviruses

These infections are characterized by a general infectious syndrome and, in addition to rashes, a varied clinical picture, including catarrhal syndrome ( pharyngitis ), diarrhea , vomiting, headaches , organ damage (eyes, liver, kidneys) and damage to the nervous system ( meningitis , encephalitis ) in older children . The rash can appear at any stage of the disease, has a characteristic localization only in some infections caused by a certain virus, and is not accompanied by itching.

Enterovirus exanthema can be caused by any type of enterovirus. Most common in children. The rash appears simultaneously on unchanged skin and at different periods of the disease - it can be on the 1-2nd day against a background of high fever or on the 3-4th day of illness after its decrease. Enteroviral diseases are characterized by high fever, often of a two-wave nature.

The simultaneous appearance of the rash is a distinctive feature that distinguishes this infection from measles, which is characterized by the sequence of appearance of the rash: the face and neck, then the torso, thighs and arms, and finally the legs and feet. At this time, the elements on the face become pale.

Enteroviral exanthema is characterized by variability. At the beginning it may be macular (punctate and larger) or maculopapular, and later it may become vesicular or with hemorrhages (hemorrhagic). It is located mainly on the torso, face, and less often on the legs and feet. The spotted elements look like a rash similar to rubella. Maculopapular lesions resemble elements of measles, which merge and form erythematous fields on the body.

A vesicular rash is characteristic of hand-foot-mouth disease. The duration of the rash is short (1-3 days), they disappear without a trace, leaving no skin defects or pigmentation. Rashes on the mucous membrane disappear within the same time frame as on the skin.

The enteroviral group includes the following exanthemas:

• morbilliform;
• Boston (synonymous with epidemic exanthema or roseoloform);
• generalized enteroviral;
• disease of the hands, feet and mouth or foot-and-mouth syndrome (this is a local variant of exanthema).

Diagnosing them without laboratory data is difficult, since they have a similar picture and nature of the rashes, especially with an atypical course.

Measles exanthema

More often observed in young children. The infection begins acutely, with fever, headache and muscle pain. At the same time, redness of the pharynx and sclera appears, there are abdominal pains and vomiting, and loose stools are also possible. From the second day of fever, signs of exanthema immediately appear on unchanged skin. The rash is always located on the face and torso, less often on the arms and legs. Signs of viral exanthema in children with this form are varied: macular, maculopapular, petechial (less commonly). The rash is small, lasts 1-2 days and goes away when the temperature normalizes.

Infectious exanthema (Boston exanthema)

Roseoloform exanthema (Boston disease) also begins acutely with an increase in temperature. In adults, the increase in temperature is more significant than in children. Fever is accompanied by headache, intoxication and prostration. The patient is concerned about a sore and sore throat, and a slight enlargement of the cervical lymph nodes. In some patients, small ulcers are found on the back wall of the throat, as with herpetic sore throat . It is the herpangina elements that make it possible to suspect infection with the ECHO virus. In uncomplicated cases, the fever lasts up to 3 days and for many the disease ends in recovery at this stage. This variant is called Boston fever.

In some patients (approximately 30%), skin rashes occur simultaneously with normalization of temperature. They appear as pinkish-red spots (small spots 0.5-1 cm in size) and are located throughout the body, with a predominant localization on the chest and face, involving the arms and legs. The rash lasts up to 3-5 days and disappears without a trace. The elements of the rash are very similar to the rash of sudden exanthema and the diseases can be confused. A distinctive point is that sudden exanthema occurs only in infants.

Boston exanthema may also be accompanied by petechial rashes. These are small red hemorrhages that do not disappear with pressure. If such rashes occur against the background of symptoms of meningitis , the disease is often mistaken for meningococcal meningitis (it is bacterial in nature, not viral). Typically, infectious exanthema proceeds benignly - without damage to the nervous system. It is observed in children of all ages and adults.

Generalized herpetiformis

This type occurs when the child has an immunodeficiency. It is characterized by the appearance of a small vesicular (vesicles with contents) rash. Unlike rashes during herpetic infection, in this case the vesicles do not group, and their contents do not become cloudy.

Disease of the hands, feet and mouth (foot and mouth syndrome) or viral pemphigus.

One of the variants of local enteroviral exanthema, which is characteristic of the infection, is caused by the ECHO 9.16 and Coxsackie A viruses. The characteristic localization of the rash (extremities and mouth) allows the diagnosis to be made clinically without serological and PCR studies. The infection most often occurs in children under 9-10 years of age, but can also occur in adults.

A characteristic feature, however, like all enteroviral infections, is that the prevalence is greater in the summer and autumn. Patients are dangerous in terms of infection 2-3 days from the moment of illness.

Patients experience febrile or high fever, moderate intoxication syndrome and respiratory symptoms, and sometimes abdominal pain. A day later, enanthema appears on the mucous membrane - earlier than the rash on the skin. It has the character of vesicles, which quickly open with the formation of aphthae (ulcerations), and a “favorite” localization: lips, cheeks, tongue, soft palate and arches. This sign greatly simplifies diagnosis. Rashes are single or multiple, but even the presence of single rashes in the mouth in combination with exanthema on the feet and hands makes it possible to make a correct diagnosis. The oropharynx is not affected by enanthema, and this fact distinguishes this disease from herpangina .

The severity of damage to the mucous membrane varies, so it may not bother the patient much or may lead to refusal to eat. The second stage appears a small vesicular rash (up to 5 mm), not itchy, on the palms, fingers and soles. Sometimes it affects the lateral surfaces of the hands and feet, buttocks, and genitals. The rashes on the limbs are always symmetrical.

In other areas there may be rashes, but rarely with single elements of a different nature - roseolous or roseolous-papular. Elements of the rash on the skin do not suppurate and disappear without crusts - this distinguishes this infection from chickenpox. It is characteristic that vesicles and papules are simultaneously found on the body. The elements disappear without a trace in 4-7 days.

Thus, the main criteria for the diagnosis of this disease are:

• fever;
• vesicles and papules on the skin of the palms and soles;
• skin rashes are painless;
• symmetry of lesions on the palms and soles;
• no itching;
• aphthous enanthema on the oral mucosa.

The disease is mild and resolves on its own without complications within a week or 10 days. But those who have recovered shed the virus for up to 6 weeks. There is an abortive variant of the infection - roseolous-papular rashes on the skin do not progress to the vesicular stage, and there are no aphthae in the mouth.

Exanthema in adults

Of all the variants of enterovirus infection, Boston exanthema . Viral exanthema in adults caused by herpevirus type 6 very rarely occurs with a characteristic clinical picture and rash. Most often, this infection occurs in the form of chronic fatigue syndrome . This is due to the fact that 95% of adults have antibodies to herpes virus type 6.

Exanthema: causes, symptoms and treatment

04.10.2021

A rash is a skin lesion that appears after taking various medications, both general and local use. Such changes can also be caused by infectious diseases. Skin lesions can take many forms, depending on what factors cause them and the general health of the patient. How can a rash be diagnosed and treated ?

Exanthema - causes

The exact mechanism of drug-induced skin damage is not fully known. One of the theories that explains this phenomenon is the so-called Hapten theory. According to her, in order for the body's immune response to occur after taking a drug, the drug must be combined with carriers, that is, proteins contained in tissues or blood . In addition to drug rash, we can talk about rashes that are caused by infectious diseases. This type of skin lesion most often appears in children, usually due to diseases such as scarlet fever and measles. In adults, the cause of an infectious rash is, for example, syphilis.

Women are more susceptible to rashes than men. Additionally, more cases of skin lesions have been reported in older people. It is estimated that skin allergies following the use of medications occur in approximately 2.2% of patients taking any medications.

The risk of rash increases due to factors such as:

• taking a lot of medications
• liver failure
• renal failure
• AIDS

Depending on the form the rash takes, there are several types.

The most common forms are:

• macular rash
• papular rash
• maculopapular rash

Macular rash is characterized by the appearance of lesions in the form of red spots on the skin. This type of skin lesion is often caused by taking antibiotics, diuretics, nonsteroidal anti-inflammatory drugs, or antiepileptic drugs. During follicular rash, blisters and papules appear on the skin, while the latter type of rash is a combination of macules and papules.

Exanthema - symptoms

Drug-induced skin lesions can take different forms in different patients. The rash can appear in different areas of the body. Changes usually occur symmetrically on both sides of the body. In the case of drug rash, the skin rashes are often located around the arms and torso. It is important that the changes gradually spread and occupy larger and larger areas of the body. Skin lesions associated with an infectious rash usually appear first around the head and ears and then spread to the lower body.

Characteristic changes for the rash include:

• acne
• hives
• dye changes
• necrotic lesions
• lichen changes

The changes are usually accompanied by itching and sometimes flaking of the skin. Drug-induced skin lesions are sometimes associated with general illnesses that include general weakness, bronchospasm, fever and headaches. In some cases, complaints related to internal organs arise. The most common complications are hepatitis, myocarditis , nephritis, and albuminuria.

Exanthema - treatment

When treating a rash, it is very important to determine its cause. It is necessary to diagnose whether the rash is drug-induced or occurs during the course of an infectious disease, because only then is effective treatment possible. If the rash is caused by a particular medication, the mainstay of treatment is to stop taking that medication. If the symptoms associated with the rash, such as itching, are very bothersome to the patient, it is recommended to take antihistamines to reduce discomfort. In case the rash is caused by an infection, you should start by treating the infectious disease. In this case, the patient is often given antibiotics or other antibacterial and antiviral drugs.

The symptoms of a rash should not be underestimated, as this can lead to serious complications. In most cases, the rash is mild, but sometimes its course is acute and can lead to toxic epidermal neurolysis, which poses a serious threat to the patient's life. It is estimated that in 0.32 to 1 percent, a drug allergic reaction results in the patient's death.

Published in Dermatology Premium Clinic

Tests and diagnostics

Diagnosis is complex and includes epidemiological history data, taking into account the symptoms of the disease and laboratory confirmation. To establish a diagnosis, information about contacts with infectious patients in any group and at home is important. In this case, the duration of the incubation period is taken into account, the dynamics of the appearance of the rash and its changes during the course of the disease are determined.

An objective examination takes into account the characteristics of the rash:

• shape of elements;
• quantity (abundant, sparse, single);
• localization;
• color and tendency to merge;
• appearance dates and order;
• evolution (dynamics);
• presence or absence of itching;
• outcome of the rash (disappearance without a trace, crusts, scars, peeling).

Some infections (for example, roseola infantum , measles , rubella , hand-foot-mouth disease ) do not cause diagnostic difficulties and the diagnosis is established on the basis of typical clinical manifestations. However, it is better to carry out specific diagnostics. Taking into account age criteria, children under 1 year of age should first of all be examined for HHV6 infection, and children over 3 years of age for parvovirus infection. Enterovirus infections occur in children of all age groups.

For diagnostics the following are used:

• Virological method of isolating a virus from biological materials and cultivating it in cell culture. The method requires more time to make a diagnosis.
• The ELISA method determines specific antibodies IgM, IgA, IgG to the HHV-6 virus or enteroviruses. Early markers include IgM titer. IgG appears later. The study of paired sera over time and a 4-fold increase in antibody titer confirm the diagnosis. The first blood test is taken no earlier than 5 days of illness. Reinfection is indicated by the detection in the early stages of the disease of not only specific IgM antibodies, but also IgG antibodies.
• The use of PCR, which detects the virus in tissues (blood, feces, saliva, nasopharyngeal washes, vesicular discharge). Sample collection is carried out under sterile conditions in the first 3 days of illness. Detection of DNA or RNA viruses (depending on the identity of the viruses) by PCR is a more sensitive method for diagnosing a primary infection. Reverse transcriptase PCR reliably differentiates any latent viral infection.
• General clinical blood tests. With roseola in infants, leukopenia , neutropenia and thrombocytopenia , the number of lymphocytes increases, and atypical mononuclear cells may appear. For many viral diseases, a lymphocytic reaction is inherent, but the most distinct one is with mononucleosis , rubella , and measles .

Treatment of exanthema in children

The contagiousness of the virus is not very high, but sick children should be isolated. There is no specific treatment. Treatment of exanthema with the correct prescriptions does not delay.

Destination:

• at high temperatures - drink plenty of fluids;
• limiting walks until body temperature normalizes;
• antipyretics;
• antiviral drugs;
• antihistamines.

During the period of treatment of exanthema in children, regular wet cleaning of the room is necessary.

Exanthema in children

Enteroviral exanthema was discussed above. Of interest is viral exanthema in children caused by human herpes virus type 6. This disease has several names - roseola infantile , sudden exanthema , pseudorubella and sixth disease . This disease has a pronounced seasonality - spring and summer. This is the most common disease of all infectious exanthems and 80-95% of children under 3-4 years old suffer from it. In practice, roseola infantum in infants is regarded as rubella or a drug allergy. It is the enlarged lymph nodes that are mistaken for a symptom of rubella. But the difference is that rubella rashes appear on the first day of the disease and mostly affect the child’s limbs.

Sudden exanthema in children most often occurs between 6 and 2 years of age and its main criteria are:

• sudden onset with fever up to 39 C;
• typical age of the child;
• high fever in a relatively normal condition of the child;
• minimal respiratory symptoms;
• the appearance of spotty rashes when the temperature drops (usually the 3-4th day);
• rashes appear simultaneously on the skin without changing color;
• the localization of the rash is more on the torso and neck, less on the face and limbs;
• there is no itching;
• generalized lymphadenopathy (enlarged cervical, axillary and inguinal lymph nodes).

Roseola begins suddenly and in some children occurs only with a high fever, which may peak with seizures, and no other symptoms. Only in rare cases is there redness of the pharynx and swelling of the conjunctiva of the eyelids, which gives the child a “sleepy” appearance. Despite the temperature, the child is active and his appetite is not impaired during periods of decreased temperature. As the temperature drops, a pink maculopapular rash appears almost simultaneously throughout the day.

The elements are slightly raised above the surface of the skin, measure 2-5 mm and are pink in color, surrounded by a white rim. The rash turns pale when pressed, rarely merges and generally persists for up to 4 days. Gradually fading away, they do not leave pigmentation or peeling. The rash first covers the face, chest and abdomen, and spreads throughout the body over the next few hours. The appearance of a rash is called the “flag of victory” over the disease, since from this period the temperature no longer rises and the recovery period begins.

Treatment

The disease tends to resolve itself and does not require treatment. First of all, because sudden exanthema refers to uncomplicated forms of herpesvirus infection type 6. Secondly, because there is no specific therapy for this disease - antiviral drugs have not been developed against type 6 herpes virus. This disease is not treated with immunomodulators. Only antipyretic drugs are used in a dosage appropriate for age. Sudden exanthema resolves without complications and is the safest infectious disease. After roseola, lifelong immunity , and children do not get sick again. After an infection, IgG antibodies to type 6 herpes virus are detected in the blood.

Sudden exanthema

The incubation period for sudden exanthema ranges from 5 to 15 days. The disease begins with a sudden increase in body temperature to high values ​​(39-40.5°C). The period of fever lasts for 3 days, accompanied by severe intoxication syndrome (weakness, apathy, lack of appetite, nausea).

It is characteristic that with sudden exanthema, despite such a high temperature, in most cases there are no catarrhal symptoms (runny nose, cough). Relatively rarely, younger children experience diarrhea, nasal congestion, enlarged cervical lymph nodes, swelling of the eyelids, hyperemia of the pharynx, and a small rash on the soft palate and uvula. In infants, pulsation of the fontanel is sometimes observed.

Body temperature decreases slightly in the morning; While taking antipyretics, children feel satisfactory. Since sudden exanthema coincides with teething, parents often explain the increased temperature precisely by this fact. Sometimes, with a sharp increase in temperature to 40°C and above, febrile convulsions develop: with sudden exanthema, they occur in 5-35% of children aged 18 months to 3 years. Febrile seizures are usually not dangerous and go away on their own; they are not associated with damage to the nervous system.

A critical decrease in temperature with sudden exanthema occurs on the 4th day. Normalizing the temperature creates a false impression that the child has completely recovered, but almost simultaneously, a pinpoint or small-spotted pink rash appears all over the body. The rash first appears on the back and abdomen, then quickly spreads to the chest, face and limbs. Elements of the rash with sudden exanthema are roseolous, macular or maculopapular in nature; pink color, diameter up to 1-5 mm; when pressed they turn pale, do not tend to merge and do not itch. The rash that accompanies sudden exanthema is not contagious. During the period of rashes, the child’s general well-being does not suffer. Skin manifestations disappear without a trace after 2-4 days. In some cases, sudden exanthema may occur without a rash, only with a febrile period.

Complications from sudden exanthema develop quite rarely and, mainly, in children with reduced immunity. Cases of the development of acute myocarditis, meningoencephalitis, cranial polyneuritis, reactive hepatitis, intussusception, and post-infectious asthenia have been described. It has been noted that after suffering a sudden exanthema, children may experience accelerated growth of adenoids and frequent colds.

Diet

Diet 15 table

• Efficacy: therapeutic effect after 2 weeks
• Timing: constantly
• Cost of food: 1600-1800 rubles per week

This group of diseases does not require a special diet and Diet 15 table . In case of diarrhea, which sometimes accompanies an infection, patients are prescribed a gentle diet: pureed soups, boiled porridges, steamed omelettes, chopped boiled meat. It is necessary to pay attention to the patient's compliance with the drinking regime (1.5-2 liters depending on age). Drinking plenty of fluids reduces intoxication syndrome, helps lower the temperature and facilitates the course of the disease.

Prevention

Since the creation of a vaccine against enterovirus infection is impossible due to the many serotypes of viruses, disease prevention consists of following the rules of personal hygiene:

• Use boiled or bottled water for drinking.
• Wash your hands after visiting the toilet and before eating.
• During the day, you should use antiseptic wipes as often as possible to prevent the virus from entering through dirty hands.
• Treating dishes and children's toys with hot water.
• Eating thoroughly washed raw fruits, vegetables and berries, if possible, treating them with boiling water. You can also use the Aquatabs disinfectant. Fruits and vegetables are immersed in a solution containing 0.004% active chlorine for 30 minutes. To obtain such a solution, take 1 tablet of the drug with a dose of 500 mg per 7.5 liters of water. After time, the fruits and vegetables are dried.
• Beware of swimming in bodies of water, try not to swallow water, and after swimming, wash your face and hands with clean water.

A set of preventive measures in children's groups includes identifying patients - sources of infection and their isolation. Disinfection is carried out in preschool institutions.

Specific prevention (vaccination) is available only for measles and rubella. Vaccination against measles is carried out with live measles vaccine in a planned manner: once every 12 months and revaccination at 6 years. Mono-vaccines against rubella are registered in Russia: Rudivax (France), rubella vaccine , and combined measles-mumps-rubella vaccine. In 2022, the first domestically produced vaccine in Russia against measles, rubella and mumps passed clinical trials. It will soon appear on the pharmaceutical market. The multicomponent vaccine is easier to tolerate, and the frequency of side effects is the same.

Vaccination of contact persons. Administration of measles vaccine up to 72 hours after contact with a sick person protects against the disease. Administration of the rubella vaccine does not prevent the disease. If a pregnant woman comes into contact with a person with rubella, administration of immunoglobulin is indicated if she does not want to terminate the pregnancy after proven infection.

Consequences and complications

The outcome of the disease depends on the severity of the infection. With mild to moderate severity of enteroviral infections, the disease ends with complete recovery with the formation of serospecific immunity. The rash disappears without a trace and no skin complications are observed.

Complications in severe cases are associated with damage to the nervous system:

• meninitis , encephalitis ;
• cerebral edema
• convulsive syndrome;
• paralysis;
• epilepsy;
• deterioration of hearing and vision.

Meningoencephalitis is typical of parvovirus B19 and enteroviruses. Pleurisy and carditis are mostly observed with Coxsackie B infection. The HHV-6 virus can cause fulminant hepatitis and Rosai-Dorfman syndrome (generalized lymphadenopathy).

List of sources

• Bystryakova L.V. Infectious exanthemas in children. L.: Medicine. 1982. 216 s
• Zubik T.M., Ivanov K.S., Kazantsev A.P. Differential diagnosis of infectious diseases. Guide for doctors. - L.: Medicine, 1991. - 336 p.
• Anokhin V.A., Sabitova A.M., Kravchenko I.E., Martynova T.M. Enterovirus infections: modern features // Practical medicine. Pediatrics. — No. 9 (85). - 2014. - pp. 52-59. 7.
• Peter G. Heger: Pediatric dermatology. Differential diagnosis and treatment in children and adolescents. 2013; 410-427.
• Drozdov V.N., Novikov A.I., Obert A.S., Belan Yu.B. Exanthematous infections in children. Lectures for intern doctors. - M.: Medical book, 2005. - 217 p.

Signs of exanthema

The incubation period (the time the pathogen remains in the body without any clinical manifestations) lasts from 5 to 15 days.

Symptoms of exanthema:

• fever - chills and hyperthermia (increase in body temperature - up to 39.0-40.5 degrees Celsius). The period lasts up to three days;
• weakness and lethargy;
• apathy (indifference to everything happening around);
• deterioration of appetite, and then its complete disappearance;
• nausea.

Less commonly, children exhibit signs of exanthema such as diarrhea, nasal congestion, swelling of the eyelids and tissues around the eyes, and a rash on the soft palate. In this case, there is no runny nose or cough. With exanthema in children, convulsions may develop against the background of the described clinical picture.

On the fourth day, the temperature drops, which creates a false impression of recovery. But almost immediately a non-contagious rash appears on the child’s body in the form of small dots or spots. It disappears after 2-4 days.