Viral Exanthems


Key Points

  • Viral exanthems are usually asymptomatic and self-limited and therapy usually is not required.
  • Recognition of the viral etiology is mostly indicated for counseling patients regarding the course of the infection and regarding appropriate isolation precautions. It is very important to make the correct specific viral diagnosis during pregnancy (laboratory testing should be undertaken), as rubella and varicella can cause severe congenital abnormalities.
  • Vaccination of infants and children for viral infections is an important and effective step towards prevention and spread.
  • Antiviral therapies, such as antiviral medications or intravenous immunoglobulin, may be indicated for severe viral infections in immunocompromised patients.

Introduction

Skin rashes are seen in a variety of viral illnesses and may be the presenting sign of disease to a primary care physician. While many of these viral illnesses are typically seen in childhood, a number of them occur in adulthood and should be considered in the setting of travel to endemic regions, particularly in patients with incomplete or waning immunity (and especially in those who have not been vaccinated).

Many viral exanthems are accompanied by an enanthem (oral mucosal lesions) which may in some cases provide clues to the etiology.

While the majority of viral exanthems are self-limited and minimally symptomatic to asymptomatic, treatment is occasionally warranted, either for the symptoms of the skin rash (most commonly pruritus) or for other organ involvement by the virus. For an overview of characteristic features, diagnosis and management of the classic viral exanthems, see table, Viral Exanthems: Features, Diagnosis & Management.

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