Everything You Need to Know About Viral Rashes

Viral infections are illnesses caused by a virus rather than bacteria or fungi. Many viral infections, especially those that tend to affect toddlers and children, can cause skin rashes.

While they can look alarming, these rashes usually aren’t a cause for concern, and they disappear once the infection clears up. Viral rashes are caused by either an immune response to the virus or damage to skin cells from the virus.

Read on to learn more about the symptoms of viral rashes, including when you should reach out to a healthcare professional.

The characteristics of viral rashes can vary greatly. However, most look like splotchy red spots on lighter skin or purplish spots on darker skin.

These spots might come on suddenly or appear gradually over several days. They can also appear in a small section or cover multiple areas. For example, a measles-related rash starts on your cheeks before eventually spreading to your torso and limbs.

Viral rashes might also feel itchy or painful to the touch. The best way to identify a viral rash is to check for any symptoms of a viral infection, such as:

• fever
• chills
• body aches
• fatigue

Measles

Measles is a highly contagious disease among people who are not protected by a vaccine. It can be dangerous in young children and infants.

The measles rash generally starts off as a red, blotchy rash on the face. Over the course of a few days, it can spread to the torso and then the rest of the body.

The rash typically consists of flat pink or red spots that appear 3 to 5 days after infection. On darker skin, it can be flesh-colored to slightly purplish-gray, with flat to slightly raised bumps.

The rash occurs because your immune system detects the virus as it travels through your bloodstream. Immune cells then release chemicals to destroy the virus. However, these chemicals also cause skin inflammation, resulting in a rash.

Symptoms of measles infection may include:

• high fever with spikes of more than 104° F (40° C)
• cough
• runny nose
• conjunctivitis, a condition where the eyes become red and watery
• blotchy rash that spreads from the face to the body

German measles (rubella)

The rubella virus, also known as German measles, typically causes mild illness in both children and adults. However, this can cause stillbirth or miscarriage and severe birth defects in developing babies.

People with rubella can pass the virus to others by sneezing and coughing as well as through their saliva. They may be contagious for a full week before they develop a rash. They’ll usually continue to be contagious for another week after the rash appears.

The rash caused by German measles typically starts on the face, and within 3 days, it spreads to the rest of the body. The rash can appear red on light skin. It may be hard to see on darker skin but feel rough or bumpy to the touch.

Symptoms of German measles can include:

• low-grade fever
• headache
• swollen lymph nodes
• cough or runny nose

Mononucleosis (mono)

Infectious mononucleosis is caused by the Epstein-Barr virus (EBV). This virus is common in teenagers and young adults but can occur at any age. A rash may occur with infection, though it is not the primary symptom.

Like its nickname — the kissing disease — suggests, mono is passed through bodily fluids like saliva.

Mono can have three different types of rashes. Mono rashes can appear as:

• A generalized rash. This looks like generalized red spots on lighter skin to pinkish-purple on darker skin, and it can be either flat or small bumps.
• A drug rash. Mono is caused by a virus and isn’t treated with an antibiotic. Someone may be mistakenly diagnosed with strep throat and treated with an antibiotic, which may result in a drug rash. The rash is usually temporary, and it will likely be itchy, raised, and splotchy.
• Petechiae. These can look like small reddish-purple dots on the skin or inside the mouth. They happen from broken capillaries. When you apply pressure, petechiae stay the same color.

Symptoms of mononucleosis may include:

• fatigue
• fever of 101°F (38.3°C) to 104°F (40°C)
• sore throat
• swollen lymph nodes
• rash

Chickenpox

Chickenpox, caused by the varicella-zoster virus, causes a rash with fluid-filled pustules. This virus is highly contagious to those who have not been vaccinated.

You can catch chickenpox by coming into contact with the saliva of a person who has the virus, such as when they sneeze or cough. You can also get the disease by touching the blisters or the liquid inside the blisters. Pregnant people can also pass chickenpox to their babies before birth.

For those who have received one or two doses of the chickenpox vaccine, milder breakthrough cases can occur, according to the Centers for Disease Control and Prevention (CDC).

The chickenpox rash typically has three phases:

1. Raised bumps appear on the skin. Depending on the color of your skin, they may appear pink, red, brown, or purplish.
2. These bumps then become fluid-filled blisters.
3. The blisters eventually burst and scab over.

Symptoms of chickenpox may include:

• itchy rash
• fever
• tiredness and feeling unwell
• headache
• loss of appetite

Shingles

Shingles infection is caused by the same virus that causes chickenpox. If you have had chickenpox, you are at risk of developing shingles.

The risk of reactivating the virus increases with age, and 1 out of every 2 people in the United States will develop shingles in their lifetime, according to the CDC.

You can get shingles from direct contact with blisters or the fluid inside them.

Shingles involves a reactivation of the chickenpox virus that’s lying dormant in your nerves. When the virus reactivates, it travels down your nerves to your skin. As the virus spreads there, the shingles rash begins to form.

Though similar to chickenpox spots in children, the shingles rash and illness are often more severe in adults. Older adults may also be at risk for complications such as nerve pain, blindness, and neurological conditions.

People who develop shingles often note that pain occurred at the site where the rash develops. Unlike the rash caused by a chickenpox infection, a shingles rash typically occurs on one side of the body, often in a single area or stripe.

Symptoms of a shingles infection may include:

• rash that can occur in a single area of the skin
• fever
• headache
• fatigue
• chills
• photosensitivity (sensitivity to light)
• upset stomach

Hand, foot, and mouth disease

Hand, foot, and mouth disease is caused by viruses in the enterovirus family. It commonly affects children under age 5, but it can affect people of any age.

It can be very contagious but does not typically cause serious illness. You can get hand, foot, and mouth disease by coming into contact with the bodily fluids of a person who has the virus. This includes:

• saliva
• mucus
• feces
• the fluid inside of their blisters

Like its name suggests, the rash associated with hand, foot, and mouth disease often occurs on those parts of the body.

People with the virus can develop painful sores on the back of the mouth and a rash on their skin. This rash can look like flat, red to purple spots or liquid-filled blisters.

While it often appears on the palms of the hands and the soles of the feet, it can show up on other parts of the body as well. Per the CDC, this might include the:

• knees
• elbows
• buttocks
• genital area

Symptoms of hand, foot, and mouth disease can include:

• fever
• flu-like symptoms
• rash
• mouth sores
• sore throat
• headache
• reduced appetite
• malaise or generally not feeling well

Fifth disease

Fifth disease is a viral illness that can cause a red rash on the cheeks or limbs. It is also known as slapped cheek disease.

In children, fifth disease can be mild, but it may be more severe for:

• adults
• people who are pregnant
• people with weakened immune systems

This virus spreads through bodily fluids, such as the respiratory particles in saliva and mucus, when a person with the virus coughs or sneezes. It can also be passed during pregnancy to an unborn child and by blood.

The rash caused by fifth disease more commonly appears in children, per the CDC. It may be itchy or go through periods of itchiness. Some people may develop a second rash on another part of the body a few days later.

Symptoms of fifth disease can include:

• fever
• rash
• runny nose
• headache
• joint pain and swelling

Roseola

Roseola, also known as sixth disease, is a contagious illness that typically affects children 6 months to 2 years old. The virus enters the body through the nose and mouth from the respiratory droplets of a person with the virus.

Children with roseola often experience a rash after symptoms of high fever and mild respiratory illness.

The rash caused by roseola tends to first appear on the trunk of the body before spreading to the arms and legs.

The spots can appear pink or slightly darker tones, depending on the color of the child’s skin. When touched, the spots may become lighter in color, a sign that the small capillaries are dilated. On darker skin, this may be harder to see.

The rash often appears as the fever decreases.

Symptoms of roseola include:

• respiratory symptoms
• sudden high fever
• fever that continues for 3 to 4 days
• swelling of the eyelids
• irritability
• rash

West Nile virus

The West Nile virus is caused by the bite of an infected mosquito. It can affect people of all ages.

Many people who have this virus don’t develop any symptoms of the disease. But 1 in 5 people may develop a fever that occurs with other symptoms, including a rash.

The West Nile virus can cause a maculopapular rash, with both flat discolored spots and raised bumps. It tends to appear on the trunk and limbs 5 days after other symptoms, such as fever and fatigue, begin.

Symptoms of the West Nile virus include:

• fever
• fatigue
• headache
• body aches
• joint pain
• vomiting
• diarrhea
• rash

Some people with the West Nile virus develop a serious and sometimes fatal illness that affects the central nervous system. Severe symptoms may include:

• high fever
• disorientation
• stiff neck
• coma
• tremors
• paralysis

Zika virus

The Zika virus is mostly spread by Aedes mosquitos that have the virus. A person who contracts the virus while pregnant can also pass the virus to their child, which may cause birth defects.

The Zika virus rash often appears as red spots and blotches that start on the face. It then spreads to the torso and limbs, including the palms of the hands and soles of the feet.

According to a 2020 study, itchiness also tends to occur with an infection.

Symptoms of Zika infection may include:

• rash
• itchiness
• joint pain
• headache
• fever
• muscle weakness
• conjunctivitis (pink eye)

Dengue fever

Dengue fever is a disease transmitted by an infected mosquito. It can cause either mild or severe illness.

Rash may occur in two phases of the disease. It can first appear as facial flushing that feels warm to the touch. A second rash can also occur 3 days to 1 week following the fever.

This rash has flat pinkish or red spots that can merge together. There may be circular areas where the skin is clear and central pinpoint spots that bleed, often called white islands in a sea of red.

Symptoms of dengue fever can include:

• fever
• rash
• nausea and vomiting
• pain behind the eyes
• muscle, joint, or bone pain

Warning signs of severe dengue usually begin 24 to 48 hours after the fever has gone down and can include:

• pain in the abdomen
• bleeding from the nose or gums
• blood in vomit, which can appear like coffee grounds
• blood in stool, which may appear like red blood or black stool

Viral infections often have to run their course. Unlike bacterial infections, they don’t respond to antibiotics, so treatment usually focuses on relieving symptoms.

You can try to speed up the healing process by drinking lots of fluids and allowing your body plenty of rest.

If you have a fever or body aches, you can take medications such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen (Advil). Parents should not give aspirin to children under age 3 without consulting a doctor.

If you have an itchy viral rash, you can try applying a cool compress or calamine lotion to the affected area. Try to avoid scratching it if you can.

For some viral infections, such as shingles, your doctor might prescribe an antiviral medication.

While it’s always a good idea to talk with a doctor when you notice a new rash, you should definitely make an appointment if you have a rash that:

• lasts longer than a week, especially if it doesn’t seem to be improving
• starts to blister
• spreads rapidly or is all over your body
• shows signs of redness, swelling, and oozing
• is painful

Many viral infections can cause a skin rash. Most viral infections clear up on their own, but some may require antiviral medication. Contact your doctor if the rash doesn’t seem to be getting any better after a week.

You should also reach out to a healthcare professional if you have a rash and live in or have recently visited a tropical or subtropical climate. Viruses spread by insects tend to be more common in these areas and may require antiviral medication.