Dear Doctor
Hi my son has this rash that has infected most of his arms, legs, groin, mouth and shoulders.
I’ve taken him to see three medical centers and all think it’s just a viral infection.
I can’t seem to accept that’s all it is. He’s screaming the house down at bed time because he can’t seem to get comfortable, he’s lethargic but is still eating and drinking though not as much as usual.
Is this not Measles?
Dear Patient
This rash is not typical of the measles rash.
It is however suggestive of a childhood exanthem which is simply a rash with symptoms like fever, lethargy, headache, irritability, muscular aches, loss of appetite and malaise (the general discomfort that your son is experiencing).
Exanthems can be caused by viruses like measles, bacteria like Streptococcus pyogenes which causes scarlet fever and by medications.
In some cases, a diagnosis of the specific cause of a childhood exanthem may not be possible due to the absence of characteristic skin lesions or any other distinctive sign or symptom.
However in many cases they are caused by viruses and the treatment of viral exanthems is symptomatic since most are self-limiting illnesses.
This means that if the patient has fever they can be given acetaminophen. Aspirin should not be used since it can lead to Reye syndrome and ibuprofen is not better since it can increase the risk of developing group A Streptococcus infection.
Antihistamines can also be taken by mouth if the rash is itchy. Medications like calamine lotion can also be applied on the skin to relieve the itch.
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