Fever and skin rashes can be present in many infectious diseases, and it is more common in children than adults. Despite the rashes, a toddler may appear well. These rashes can be due to immune reactions of the body towards the virus or other pathogen. A skin rash during fever can be more serious than a rash developing after fever. Sometimes bleeding spots may be confused with rashes.
Read this post to learn about the various infectious diseases that cause skin rashes in toddlers after a fever.
Causes Of Rashes After Fever In Toddlers
The following conditions may cause rashes in toddlers after a fever.
Roseolainfantum, also called the sixth disease, three-day fever, exanthemsubitum, or pseudo-rubella, is common in toddlers. This is caused by human herpesvirus-6 (HHV-6) (1). Another strain of herpes virus, herpesvirus-7, may also cause roseola in toddlers in rare cases.
Fever in roseola: The infection may begin with a high fever, often ranging from 102°F to 105°F (38.8°C to 40.5°C) in children below two years of age. The fever may last for three to seven days and often present with the following symptoms.
- Runny nose
- Lack of appetite
Rash in roseola: The skin rashes appear after the fever subsides, usually 12 to 24 hours after the fever. This is the difference between roseola and measles. In measles, the fever spikes as the rashes appear whereas in roseola, the appearance of rashes coincides with remission of fever. Slightly raised pink rashes on the belly, chest, and back of the body are seen in roseola. Roseola is not diagnosed until rashes appear, and most toddlers are no longer contagious 24 hours after the fever resolves. The rash may last for one to three days, and most children are fine by the time the rash appears.
Treatment for roseola: There is no specific treatment for roseola in toddlers, and the condition may run its natural course. However, it is recommended to seek pediatric care for fever spikes since it may cause febrile seizures in some toddlers.
2. Hand, foot, and mouth disease (HFMD)
Hand, foot, and mouth disease (HFMD) is a viral illness caused by viruses belonging to the enterovirus family. Coxsackievirus A16, coxsackievirus A6, and enterovirus 71 (EV-A71) are common viruses associated with HFMD in toddlers. Most children may get HFMD by five years of age (2).
Fever in HFMD: This disease may begin with mild fever, sore throat, and lack of appetite in toddlers. Painful mouth sores are seen one or two days after the fever. These sores may begin as small red spots and become blisters. Fever may subside within three days in most toddlers. Eating or drinking issues due to painful swallowing and drooling are also seen in HFMD.
Rash in HFMD: Toddlers may develop red spots on the palms and soles. The rashes may spread to the buttocks, limbs, and genital area in severe cases. The rashes initially look like raised red spots, but later become blister like in appearance.
Treatment for HFMD: There is no specific cure for HFMD, and it may resolve within seven days after running its natural course. Children may require fever medications and hydration to prevent dehydration. Severe infection may affect fingernails or toenails, causing them to fall off. You may consult a pediatrician in such cases (3).
3. Fifth disease
Fifth disease, also known as erythema infectiosum or slapped cheek disease, is a mild rash-causing viral illness due to parvovirus B19. Bright red rash on the cheeks gives the name “slapped cheek disease,” and the other name, the fifth disease, comes from an order of old classifications of viral skin rash diseases in children (4).
Fever in the fifth disease: Cold-like symptoms such as runny nose followed by mild fever is characteristic of this condition. Fever may last seven to ten days, and children are contagious during this time.
Rash in the fifth disease: Rosy cheeks may appear as “slapped cheek” or “slapped face” and are usually seen seven to ten days after fever. This rash can be slightly raised with lace-like patterns and often spread to the body and limbs. Fifth disease rash often disappear in seven to ten days. In some toddlers, the rash may come and go for several weeks in various parts of the body. Fifth disease is more a disease of the older children than toddlers.
Treatment for the fifth disease: This is a mild childhood illness that goes away without specific treatments. Healthy children may recover without complications. However, if your child has any health condition, the symptoms may worsen, requiring medical care.
Many other diseases, such as measles and scarlet fever, can cause skin rashes and fever in toddlers. However, these conditions may usually cause fever during the onset of skin rash. Although it is possible to have skin rash after seven days of illness in scarlet fever, this condition is rare in toddlers due to maternal antibodies. Also, in dengue, sometimes after the fever subsides, red, flat, non blanching rashes may appear which are bleeding spots. These children should immediately be taken to their doctor.
Home Management Of Skin Rashes After Fever
Most viral illnesses require time to run their course, and most toddlers feel better after the fever ends. Viral rashes after fever may not require treatment since it fades away in a short time. You may try the following home care measures during these illnesses to ease the symptoms.
- Provide hydration: Give plenty of fluids to your toddler during febrile illnesses to prevent dehydration. You may give clear fluids such as water, clear broth, diluted fruit juices, coconut water and oral rehydration solutions, to the toddler to replace water and electrolyte loss. Toddlers who breastfeed should continue to breastfeed as usual.
- Ensure plenty of rest: Make sure your toddler is getting enough rest and sound sleep during illness since it could aid in recovery.
- Sponge baths: You may clean your toddler with a cool washcloth or lukewarm sponge bath during fever to prevent chills and discomfort due to bathing. It is better to avoid cold water, ice packs, and cold room temperature during febrile illnesses in toddlers. A lukewarm water bath may be given.
- Medications: You may give fever medications to the toddler as per the doctor’s directions. You may also consider skin medications and lotions as per the doctor’s recommendations to relieve any rash-related skin irritation in the toddler. For oral ulcers, soothing gels might be applied on a doctor’s prescription only.
- Soft and cold foods: Sore throat, mouth ulcers, and rashes around the mouth may make it difficult for a toddler to swallow and chew food. Soft food items, such as vegetable mash, or liquid-based food items, such as smoothies and soups, brought to room temperature, could be ideal options during this phase. Good nutrition during illness is important to bring the child back to his pre-illness health. Since consumption is decreased during illness, more frequent and calorie dense feeding may be given. This may be achieved by adding oil or ghee to each feed.
While you take care of the toddler, ensure your safety. Wash your hands with soap and water before and after touching the child during these illnesses to prevent spreading it yourself and others.
When To See A Doctor?
You may contact the pediatrician if your toddler has a fever lasting for more than three days or has a high temperature. Rashes after fever can be managed at home as per the doctor’s suggestions. However, worsening rashes or rashes lasting longer than usual could require medical care. Any non-blanching rash, or any rash accompanied by other bleeding manifestations , should be immediately brought to a doctor’s notice.
Roseola, HFMD, and fifth disease can cause skin rashes after fever in toddlers. The rashes often appear 12 to 24 hours after the fever subsides. Usually, doctors can diagnose the condition based on the type of rash and area involved. Though the symptoms may go away without specific treatment in most children, you may seek medical care if the rashes worsen. Further, supportive therapies to reduce or relieve the symptoms may be offered. Adequate hydration, sponge baths, rest, and a nutritious diet are essential while recovering from infectious diseases.
Infographic: Symptoms To Identify Diseases That Cause Fever And Rash
Several illnesses may cause fever with rashes. However, certain additional symptoms may assist in quick diagnosis. Go through the infographic below that lists such accompanying symptoms.
- Skin rash after the fever is a common occurrence in children.
- Roseola, Hand, foot, and mouth disease (HFMD), and Fifth disease may cause rashes in babies and toddlers after fever.
- Viral rashes after fever subside with basic home care practices, such as optimum hydration and sponge baths.
- Medical intervention is necessary in case of high-grade fever, the rashes are worsening, or are staying longer than usual.
- Roseola-Viral Rash; Seattle Children’s Hospital
- Hand Foot and Mouth Disease (HFMD); Centers for Disease Control and Prevention
- Hand-Foot-and-Mouth Disease- Viral Rash; Seattle Children’s Hospital
- Fifth Disease; Centers for Disease Control and Prevention.
- Roseola infantum; Australian Government Department of Health
- Viral Exanthem Rash; Cleveland Clinic
- Rashes; The Royal Children’s Hospital Melbourne
Dr Bisny T. Joseph
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Dr. Shaon Mitra(MD)
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