Doctor in the House: Has your child developed a rash with fever? Here’s what she could be suffering from - The Indian Express

Several childhood illnesses that cause fever are associated with rashes. Most are viral illnesses, which may be unpleasant but go away on their own. In some cases though, it may be due to a more serious illness like a meningococcal infection or a drug reaction. Parents should always consult a doctor when the child looks unwell with a rash or if symptoms get rapidly worsen. Let's look at a few illnesses with a rash.

Roseola
This is a virus from the herpes family, presenting with a fever and runny nose, generally in children below three years of age. The rash starts on the third or fourth day as small red bumps with a halo around it. It usually starts on the face and eventually spreads to the whole body. The rash characteristically appears once the fever starts waning. Children with roseola may be quite irritable. There is no specific treatment for this condition as the rash disappears on its own.

Fifth disease
Slapped cheek disease or fifth disease is caused by Parvovirus B19. It is called "slapped cheek disease" as it produces a dark red rash on both cheeks. The incubation period can be as long as two weeks and presents with fever, headache and runny nose. On day four or five, the rash spreads to both cheeks and then to the whole body. Some slightly older children may complain of body ache that can last up to three weeks. Similar to roseola, the rash presents after the fever subsides. In some cases, it may cause anaemia. The child remains contagious during the febrile phase but not when there is the rash.

Scarlet fever
This, unlike the first two fevers, is caused by a bacteria called Group A streptococcus. This presents with fever, sore throat, a rash and the child appears to be quite unwell. Most of these children with strep throat need antibiotics.

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Chicken pox
Chicken pox is caused by the varicella-zoster virus. We don't see a lot of chicken pox these days as most children who have received two doses of the vaccine are protected. If they do get it even after the vaccine, it is very mild.

It begins with fever, headache and malaise and the rash appears two or three days later. The rash appears as fluid-filled blisters all over the body, mainly on the torso. They are extremely itchy, and when scratched, may lead to scarring. In most cases, the child is better within a week. In immunocompromised children, it can produce a more serious illness.

Hand-foot-and-mouth disease
Most parents are aware of this illness as it seems to be doing the rounds in nurseries and schools. It is caused by the Coxsackie group of viruses and is usually seen in children below five years, though it can produce disease in older children, too. It usually starts with fever and then goes on to develop a rash involving the hands, feet and the mouth. The lesions in the hand and feet may be mildly itchy but the mouth ulcers are painful. No specific treatment is needed except for pain relief and hydration. The lesions usually heal within seven to 10 days.

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Meningococcaemia
This is a serious blood infection caused by a bacteria called Neisseria meningitidis. There are many strains of this bacteria which cause this disease. It presents with fever, joint pain, muscle pain and fatigue, this is followed by a red petechial rash that spreads over the body. This is a very dangerous illness and can cause complications like septic shock.

Cellulitis
Cellulitis is a serious bacterial skin infection that affects the deeper layers of the skin. It usually appears following an injury to the skin such as an insect bite. The skin appears tender and red and you can see red streaks radiating from the rash, indicating that the infection is spreading. If the rash is accompanied by fever, it usually denotes a more serious infection. Antibiotics are usually needed to treat the infection.

Drug reactions
In certain cases, rashes appear after the use of medication. This requires a visit to the doctor, as you need to consult the doctor if you feel it may be due to the medication the child is taking.

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Treatment
As most fevers with rashes are caused by viruses, no specific treatment is required. Antibiotics don't treat viral illnesses and hence should not be given. Only antipyretics like paracetamol and hydration are required. If an antibiotic has been prescribed, for example for cellulitis, please make sure the antibiotic course is completed.

When to call the doctor:

– fever with cellulitis
– when you notice skin peeling following a fever
– the rash appears a day or two after the medication and you suspect a drug rash
– if there is any swelling in any part of the body or baby develops breathing difficulty

Most rashes are harmless and they usually develop when fever settles and disappears on their own without any treatment. At any point, if you are not sure or your baby develops high fever, please speak to your doctor to discuss the course of action to be undertaken.

Dr Saroja Balan is consultant neonatologist and paediatrician at the Indraprastha Apollo Hospital, New Delhi. Her column appears every fortnight

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