What Is a Maculopapular Rash?

Medically reviewed by Debra Sullivan, PhD, MSN, CNE, COI on March 21, 2017Written by Marjorie Hecht on March 21, 2017

Overview

A maculopapular rash is made of both flat and raised skin lesions. The name is a blend of the words “macule,” which are flat discolored skin lesions, and “papule,” which are small raised bumps. These skin lesions are usually red and can merge together. Macules that are bigger than 1 centimeter are considered patches, while papules that are merged together are considered plaques.

A maculopapular rash is a marker for many diseases, allergic reactions, and infections. Most of the time, the cause is a viral infection. See a doctor if you have a maculopapular rash. The rash could indicate a serious disease.

What does a maculopapular rash look like?

A maculopapular rash could be due to a variety of conditions, but the most distinguishing feature is the pattern of macules and papules.

How can you identify a maculopapular rash?

A maculopapular rash looks like red bumps on a flat, red patch of skin. The reddish background area may not show up if your skin is dark. The rash is sometimes itchy, and it can last from two days to three weeks depending on the cause.

How quickly the rash appears and where it appears on your body will differ depending on the cause of the rash. It can spread anywhere on the body, from the face down to the limbs. In some cases, your doctor may ask where the rash started on the body. This can help the doctor narrow down potential causes.

Since maculopapular rashes are most common in infections and body immune responses, more than one symptom may also appear. These include:

  • fever
  • headache
  • vomiting
  • breathing troubles
  • muscle pain
  • dry skin

This may be a sign of an infection, which may be potentially contagious. Only a doctor can provide an exact diagnosis. Make an appointment with your doctor if you have a maculopapular rash and other symptoms.

What are possible causes of a maculopapular rash?

Maculopapular rashes may be present in many different conditions. Some may be due to:

  • drug reactions
  • bacterial or viral infections
  • allergies
  • our body’s own systemic inflammation

Drug reactions

Allergic reactions to a drug may be the cause if the maculopapular rash develops four to 12 days after taking a medication. Reactions to medications can take up to seven or eight days to show symptoms. You may experience a low-grade fever and muscle pain. The rash generally fades after one to two weeks.

Read more: Identifying and caring for an amoxicillin rash »

Infection

If a viral or bacterial infection is the cause of your rash, you will also experience other symptoms such as a fever, headache, muscle pain, and breathing troubles. Possible viral causes include:

Allergic reaction

A rash that breaks out immediately may also be due to allergies. This usually happens within minutes to hours of exposure to the allergen. Sometimes a maculopapular rash may break out before hives do. A person may also experience increased heart rate and breathing problems.

Body’s systemic inflammation

The body’s own systemic inflammation can cause maculopapular rashes. Inflammation is how your body responds to an injury or infection. A drug reaction, infection, an autoimmune response, or allergic reaction can cause your body’s immune system to respond and develop maculopapular rashes.

How will a doctor assess your rash and find the cause?

It’s best to see a doctor if you break out in a maculopapular rash. Diagnosis can be difficult because there are so many possible causes for the rash.

Your doctor will ask about your medical history and whether you’ve traveled, and they will conduct a physical exam. They’ll look at where it started and how the rash has spread. They’ll also ask questions to determine the cause of the rash.

The doctor will likely ask:

  • When did your rash appear?
  • Do you have other symptoms, such as fever, sore throat, fatigue, diarrhea, or conjunctivitis?
  • What medications and over-the-counter drugs are you taking?
  • Do you have any other diseases, such as a heart condition or diabetes?
  • Have you had allergic reactions in the past to drugs, or foods, or insect bites?
  • Have you traveled recently to an area where mosquito-borne diseases such as Zika or chikungunya are present?
  • Have you been in contact with people or animals that may have a contagious disease?

Depending on the course of your rash and your history, the doctor may order a blood or urine test. The doctor may also do a skin biopsy and refer you to a skin disease specialist.

How will your rash be treated?

Treatment of your rash depends on the cause. For immediate treatment to relieve itching, your doctor may also prescribe antihistamines or topical steroids. You can also use over-the-counter drugs such as hydrocortisone creams or Benadryl. As mentioned before, be sure to see a doctor first before taking these over-the-counter drugs. You don’t want to treat the symptom without knowing the cause.

Drug reactions: If the maculopapular rash is a drug reaction, the doctor will have you stop the medication and try a substitute, if necessary.

Infections: If the cause of the rash is a viral infection or a bacterial infection, you will be treated for the particular disease. For example, a maculopapular rash caused by the Zika virus has no specific treatment. In the case of Zika, you will be advised to rest, drink plenty of fluids, and use over-the-counter painkillers if necessary.

Allergic reactions: Topical steroid creams and wet wraps can help with inflamed skin. Your doctor may also prescribe antihistamines.

Body’s systemic inflammation: This treatment depends on your condition and what’s causing your body’s immune system to react.

Sometimes the diagnosis may not be immediately clear, and the doctor may order more tests.

Read more: How to treat an HIV rash »

What are possible complications?

You may feel pain and itchiness due to the rash, but complications are unlikely to arise from the rash itself. What complications arise depend on the underlying cause. For example, you may develop life-threatening allergic reactions (anaphylaxis) with certain drugs, which causes a skin reaction. Or you may develop headaches, a stiff neck, or back pain from an infection. As mentioned before, be sure to see a doctor who can look at all the symptoms you’re having and make a diagnosis.

Zika virus complications

You may be particularly interested in the Zika virus, as the maculopapular rash is often associated with this virus. The complications of the Zika virus can affect your baby, even if you had mild symptoms. The World Health Organization (WHO) has declared Zika a public health emergency because of the high incidence of microcephaly (underdeveloped head size) in babies born to women who had the rash in the first three months of their pregnancy.

There is also evidence that Zika causes another serious neurological disorder called Guillain-Barré syndrome.

It’s important to see your doctor if you’re pregnant and may have been exposed to Zika. Zika passes through mosquitoes or by having sex with someone who had the Zika virus. The WHO advises that pregnant women practice safe sex with condoms or abstain during the course of pregnancy.

What’s the outlook for maculopapular rash?

There is a wide range of causes for this type of rash and a wide range of outcomes. Allergic reactions and minor reactions to drugs generally clear up quickly. Most childhood viral and bacterial infections have a known and limited course. Once your doctor diagnoses the cause of the condition, they’ll be able to provide an outlook based on your case.

What to do if you have a maculopapular rash

Use medications as prescribed, including antihistamines and skin creams. Follow the doctor’s instructions for recovery, and take care not to infect others if the cause of your rash is infectious.

Use insect repellant and take measures to eradicate mosquitoes in and around your neighborhood. Always follow up with your doctor if your rash is interfering with your day-to-day life.

Keep reading: Skin rashes, pictures, and causes »

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