Maculopapular Rashes Causes (With Pictures)

Skin eruptions are very common symptom in various conditions. Every one of us has seen it almost daily in our lives. Doctors classify the rashes based on their types, texture, distribution, size, colour etc.

Based on its appearance (morphology) there is a huge list of rashes. Let us first see about the two basic lesions, macules and papules.

Difference between Macules and Papules

Macules are lesions that have change in colour, but not elevated or depressed from the rest of the skin surface [1]. They measure less than 10mm in diameter. Papules are elevated lesions which are less than 10mm in diameter [1].

They may arise from the trunk and then spread over to the periphery (centrally distributed) or first erupt in the limbs and then spread towards the trunk (peripheral eruptions).

Centrally Distributed maculopapular eruptions

Measles/ First disease/ Rubeola

A viral infection causing the most common rashes in children is Measles. It is a very contagious infection that spreads through the respiratory tract and has a secondary attack rate of 90%. At first the infection may look like a common cold, with fever and sore throat. The cervical lymph nodes may be enlarged. During the subsequent days Koplik’s spots which are characteristic of measles, appear in the mouth. The rashes on the body are generally flat, but can be raised too. Frequently it can be seen that these rashes may join together while spreading on to other areas.

Measles is diagnosed clinically rather than through investigations. But it can be confirmed by detection of antibody to measles virus in the blood. Supportive treatment with antipyretics to bring down the fever and Vitamin A supplementation can be done. Complications of measles include acute otitis media, diarrhoea, encephalitis or pneumonia [48].

Measles Rash Images

Pic 1: Measles infection in a child.
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Pic 2: Measles rashes seen all over the body of a child.
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Pic 3: The white spots seen in the oral mucosa are called Koplik’s spots.
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A similar infection like Measles is Rubella. It is a highly contagious disease with a secondary attack rate of 85%. The presentation of the condition is usually with rash, swollen lymph nodes, elevated temperatures, joint pains etc.

For diagnosis of rubella antibody detection in blood or saliva can be done [49]. No specific treatment is available for rubella infection. Supportive measures to prevent dehydration by giving more fluids to drink and reduction of fever by anti-pyretics can be given [50].

Infection with rubella during pregnancy can increase chances of miscarriage or chances of the baby being born with congenital defects such as cataract, ventricular septal defect and sensory neural deafness. The highest chance of mother transmitting the infection to unborn child during pregnancy is if she gets infected during the first trimester (Up to 12 weeks of pregnancy) [51].

Rubella Rash Images

Pic 4: Rubella rash
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Pic 5: Rubella rash
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Pic 6: Rubella rash on the back
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Rash due to Erythema infectiosum

The name itself gives out the idea of the condition. A viral group called as Parvovirus is the causative organism for this disease. Erythema which means redness is seen on the face. It gives an impression that the face has been slapped. Hence it is called as a ‘Slapped cheek appearance’. The condition is transmitted by the respiratory route and causes fever, running nose, sore throat and headache. 1-2 weeks with no symptoms then follows. Rashes appear after the intervening asymptomatic period. Maculo-papular rashes that resembles lace may appear [7].

Diagnosis of this condition is by clinical examination. For confirmation, antibiotic study can be done. Antihistamines to reduce the itching may be needed [52]. The condition resolves by itself. In people who are having decreased immunity, erythema infectiosum may lead to aplastic anaemia [53].

Erythema infectiosum Rash Images

Pic 7: Erythema infectiosum in a child. Note the appearance of the cheeks.
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Pic 8: Erythema infectiosum
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Pic 9: Erythema infectiosum
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Exanthem subitum

An infection which is commonly seen in infants caused by a Herpes group of virus Exanthum subitum [2, 8, 9]. A high grade fever followed by abrupt drop in temperature in around 4-6 days characterizes the disease. Febrile seizures can be seen in few infants. Rashes seen on neck and trunk appear following the drop in temperature.

Antibody detection in serum can confirm the diagnosis. Supportive treatment for fever is usually provided. But, a definitive treatment is not yet found. Pneumonia or encephalitis may occur in people with lower immunity [54].

Exanthem subitum Rash Images

Pic 10: Roseola infantum rash.
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Pic 11: Roseola infantum
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Pic 12: Rash due to Roseola
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Pic 13: Rashes due to Roseola
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Primary HIV infection

In HIV, the immunity of the person falls rapidly during the primary phase. Since the immunity is low a variety of infections like, bacterial, viral, fungal or parasitic infections may occur. Based on the causative agent of the infection, rashes can be seen in the sufferers. These are generally non-specific maculo-papular rashes.[2, 10, 11].

Primary HIV infection Rash Images

Pic 14: Rash due to Kaposi’s Sarcoma in an HIV infected patient.
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Pic 15: Herpes zoster infection in an HIV infected patient.
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Pic 16: Molluscum contagiosum in a patient with HIV
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Pic 17: Exacerbation of psoriasis in an HIV infected patient.
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Infectious mononucleosis/Mono

Infectious mononucleosis is caused by Human Herpes Virus 4, more commonly known as Ebstein-Barr virus. The spread of infection is through respiratory route. As the name suggests, it is highly contagious. It is seen to spread easily in young people who are intimate, thus giving it a name of ‘Kissing disease’ [2, 12, 13, 14].

Peri-orbital oedema, urticaria, petechiae and maculo-papular rashes may appear in some patients, Generally they present with enlarged lymph nodes, fever and sore throat.

Antibody detection by Paul-Bunnell test or Monospot test can confirm the diagnosis of Infectious mononucleosis [55]. Antiviral medications are not of much use in Mono. Corticosteroids may be required in cases with impending airway obstruction [56].

Complications such as encephalitis, cranial nerve palsies, neuropathy, splenic rupture or airway obstruction may be seen in few cases [57].

Infectious mononucleosis/Mono Rash Images

Pic 18: Infectious mononucleosis rash
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Pic 19: Rash in case of a patient with infectious mononucleosis
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Pic 20: Infectious mononucleosis. Large tonsils may obstruct the airway.
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Drug induced eruptions

Drug reactions are one of the common occurrences that are commonly seen in clinical or hospital practice. Generally the patients present with rashes over the body with itching and swelling. It is frequent to see people having difficulty in breathing due to drug reactions. In severe conditions the patient may present with anaphylaxis and shock. Treatment with cortico-steroids maybe necessary in such cases.

Drugs such as penicillins (amoxycillin), sulfa containing antibiotics (Bactrim), anticonvulsants, non-steroidal anti-inflammatory drugs such as aspirin, Tylenol (Acetaminophen), Gabapentin are known to cause drug reactions in a large number of population around the globe [15, 16].

Drug induced eruptions Rash Images

Pic 21: Rashes due to medication.
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Pic 22: Rashes seen following medication.
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Pic 23: Rashes following treatment with amoxicillin
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Pic 24: Rashes appeared following treatment with antibiotics.
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Typhus Fever

Rickettsia prowazekii causes Epidemic typhus and is transmitted by louse. Maculo-papular rashes with fever, pain in the muscles and nausea and vomiting characterizes this condition.

When the immunity becomes low, these organisms may get reactivated to cause Brill-Zinsser disease[17, 18, 19, 20].

Rickettsia typhi is the organism causing Endemic typhus (Murine typhus) and is transmitted by rat flea. This can be characterized by Rashes, fever, nausea, vomiting and muscle pain.

Diagnosis is chiefly by history and examination of the patient. Antibody detection in serum can confirm the diagnosis. Treatment should be immediately started with antibiotics [58]. Depending on the organs of involvement, if left untreated, typhus fever can cause complications such as heart failure, respiratory failure, kidney failure, hypovolemia, seizures, coma and death [59].

Typhus Fever Rash Images

Pic 25: Eschar and Typhus fever rash
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Pic 26: Rash in a case of epidemic typhus
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Pic 27: Rash in epidemic typhus
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Pic 28: Rash in Endemic typhus
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Scrub typhus

Orientia tsutsugamushi which is transmitted by mite causes Scrub typhus. Following the mite bite, an eschar forms. Multi system involvement may include heart, lungs and the nervous system. High grade fever with eschar formation and associated symptoms of body ache and tiredness are generally seen in scrub typhus[21].

An appropriate history with recent travel history to scrub typhus endemic areas is important for diagnosis. Antibody detection from serum is useful in confirmation.

Treatment with antibiotics at the earliest is required for scrub typhus [60]. If not treated in time, scrub typhus may cause renal failure, shock and disseminated intravascular coagulation [61].

Scrub typhus Images

Pic 29: Eschar in scrub typhus.
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Pic 30: Eschar- scrub typhus.
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Pic 31: Eschar on scalp- Scrub typhus
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Lyme disease

Borrelia burgdorferi is one of the most common organisms that causes Lyme disease. A red area that expands (erythema migrans) can occur at the site of bite by a tick[22, 23]. Joint pains, headache, palpitations, facial paralysis etc may also be seen in a case of Lyme disease.

A ‘Bull’s eye’ appearance may be seen occasionally. Joint pains and swelling may recur later. A complete history with person being in tick endemic areas may suggest the cause. Serological test for antibodies can confirm the diagnosis. Antibiotics are used to treat the condition. If untreated, Lyme disease may cause, heart rhythm abnormalities, impaired memory, facial palsy, neuropathy and arthritis [62].

Lyme disease Rash Images

Pic 32: ‘Bull’s Eye’ Appearance in Lyme’s disease.
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Pic 33: Erythema migrans seen in Lyme’s disease
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Pic 34: Erythema migrans rashes
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Pic 35: A lesion showing ‘Bull’s eye’ appearance of rash in case of Lyme’s disease.
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Enteric fever/ Typhoid fever

Contaminated food and water has always been a breeding point for Enteric fever [24, 25]. The organisms Salmonella typhi and paratyphi are those that causes the infection which is characterized by high fever, joint pains, rashes (rose spots) and headache. The rashes usually usually appear around 7th to 12th day from the start of the symptoms of typhoid, in groups of around 5 to 10 macules over lower chest, upper abdomen and back [63].

Culture of blood, urine and stool can be used for the diagnosis of enteric fever. Widal test is one of the serological tests used for diagnosis, but not considered acceptable now [64]. Other antibody detection methods or PCR (polymerase chain reaction) can be used [64].

Treatment with antibiotics along with supportive measures is needed for this condition. If left untreated enteric fever can lead to intestinal perforation (holes in the intestine) [65].

Enteric fever/ Typhoid fever Rash Images

Pic 36: Rash in typhoid fever.
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Pic 37: Typhoid fever- Rose spots
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Pic 38: Typhoid fever- Rose spots.
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Dengue fever

One of the most common mosquito to cause various infections is Aedes aegypti. This is the one which transmits Dengue fever too. Dengue fever, which is also known as ‘Break bone fever’ has a characteristic feature of severe bone pains, high fever, severe headache with retro-orbital pain and tiredness. There can be rashes on the body which can give a flushed appearance.

‘Islands of white in a sea of red’ is a common expression to describe the rashes in dengue fever. In few people dengue fever may complicate into Dengue Haemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS) [26, 27].

Diagnosis of dengue fever is done clinically by a tourniquet test and confirmation can be done by NS1 antigen and IgM and IgG (Immunoglobulin M and G) detection in the serum. Supportive treatment with antipyretics to reduce fever and pain along with plenty of fluids to drink helps in improvement of the patient’s condition.

Dengue fever Images of rash

Pic 39: Rashes – Dengue
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Pic 40: Rashes -Dengue fever
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Pic 41: Dengue fever rashes
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Pic 42: Rash- dengue fever
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Relapsing fever

Epidemic relapsing fever is also known as louse borne relapsing fever as it helps in transmission of the Borrelia recurrentis which is the causative agent. Ticks are the vector in case of endemic relapsing fever which thus is rightly called as tick borne relapsing fever. The causative agent for endemic relapsing fever is Borrelia hermsii.

Recurrent high fever and periods of severe hypotension is characteristic of this fever which may turn fatal if not given the appropriate care [28, 29, 30, 31].

Diagnosis of relapsing fever is by finding spirochetes in blood smear and by PCR. Treatment is done with antibiotics [66].

Relapsing fever Rash Images

Pic 43: Rash seen in relapsing fever.
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Systemic Lupus Erythematosis (SLE)

Everyone knows that our body is protected by our own defense mechanism. But Imagine what would happen if that defense mechanism turns against our own body. It would be called a military coup in real life terms. A similar scenario occurs in our body too which can result in a number of disorders, one of which is SLE.

It is a condition characterized by fever, joint pain with multiple organ system involvement. A rash may be seen below the eyes on both the cheeks. The sides are connected with a patch of rash on the bridge of nose. Thus it gets the name malar rash/butterfly rash. The areas which are more prone to exposure to sun, can show macules or papules[32, 33, 34].


Systemic Lupus Erythematosis (SLE) Images

Pic 44: ‘Butterfly rash’
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Pic 45: ‘Butterfly rash’ in Systemic lupus erythematosis
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West Nile fever

It is known that birds are the natural hosts of West Nile fever virus. When they get bitten by mosquito, the diseases is carried by the mosquitoes and then transmitted to the human beings. The disease in humans mostly are asymptomatic. Few infected persons may complain of fever, body ache and head ache with skin rashes. Occasionally, it may cause neurological diseases [35, 36, 37].

Antibody detection in blood, EEG and CSF examination may be required for confirming the diagnosis. Generally, supportive measures to manage pain and fever would be sufficient in treatment of the case [67].

West Nile fever Pictures of Rashes

Pic 46: Rash in West Nile fever
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Pic 47: Rash- West Nile fever
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Peripherally distributed maculopapular eruptions

Rocky Mountain spotted fever

Rickettsia rickettsii an organism that is transmitted by ticks causes Rocky Mountain Spotted Fever. The disease is due to vasculitis as a result of the infection. This causes high fever, headache, muscle pain, nausea and rashes[38, 39]. The rashes are petechial, non itchy lesions, that first appear on the ankles and wrists. Later on they spread to other parts of the body including palms and soles.

Serious complications such as heart failure, encephalitis, lung failure and kidney failure may occur if left untreated [68]. Treatment is usually with antibiotics [68].

Rocky Mountain spotted fever Rash images

Pic 48: Rashes of Rocky Mountain Spotted fever on a child’s forearm and hand.
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Pic 49: Petechial rashes of Rocky Mountain spotted fever on leg.
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Pic 50: Rocky Mountain Spotted fever- Rashes on ankles, legs and soles.
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Secondary syphilis

Syphilis is one of the more common sexually transmitted disease that can be treated and cured well. Nevertheless, it can be dangerous if not treated appropriately.  The stages of syphilitic progression includes primary, secondary, latent and tertiary. The secondary stage is characterized by generalized rashes but mostly seen on palms and soles. Generalized lymphadenopathy (enlarged lymph nodes) and condyloma lata (wart like lesion in the genitalia and perineum) are also features of secondary syphilis.

When secondary syphilis is not treated, the symptoms resolve by themselves and the infection goes to a latent stage to develop further into tertiary syphilis which is much dangerous. Serological tests help in diagnosis of the condition. Treatment must be given with antibiotics[40, 41, 42].


Secondary syphilis Rash Images

Pic 51: Image shows rashes seen in secondary syphilis, in palms.
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Pic 52: Secondary syphilis with rash over trunk.
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Pic 53: Secondary syphilis- generalized rashes
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Pic 54: Secondary syphilis- Rashes on soles.
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Chikungunya fever

Aedes aegypti is the vector that transmits this viral infection. In Chikungunya, the major present is fever with severe joint pains. The joints may be swollen. Headaches are frequently complained about by the patients. Rashes may or may not be present [43, 44, 45].

A clinical diagnosis is mostly done in patients with Chikungunya fever. For confirmation antibody detection can be done. Supportive treatment to reduce pain and fever may be required in most of the patients. Arthritis due to Chikungunya fever may persist for months or years.

Chikungunya fever Rash Images

Pic 55: Rash – Chikungunya
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Pic 56: Rash – Chikungunya
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Hand-foot-and-mouth- disease (HFMD)

HFMD is a viral disease which is highly infectious and seen mostly in children below the age of 10 years. Usually it is transmitted from already infected persons through direct or indirect contact.

Coxsackie virus which may present as a upper respiratory infection with fever, running nose and sore throat progresses further with rashes on the various parts of the body. The rashes may become blisters and tend to burst. These can be itchy and painful too.

The disease cures by itself without any treatment. A clinical diagnosis is sufficient to start supportive treatment for fever and to reduce itching of the rashes[46, 47].

Hand foot and mouth disease – Rash images

Pic 57: HFMD rashes
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Pic 58: HFMD rashes
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Pic 59: HFMD rashes
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  2. Harrison’s Principles of Internal Medicine, 19th Edition, Page 128
  26. “Dengue and severe dengue Fact sheet N°117”. WHO. May 2015.
  27. Gould EA, Solomon T (February 2008). “Pathogenic flaviviruses”. The Lancet. 371 (9611): 500–9.
  28. Hayes SF. Biology of Borrelia species:381-400.
  29. Dworkin MS, Borchardt SM:449-68, viii.
  30. Greenfield RA, 2008 Jul:521-30
  31. Sanford JP. Relapsing fever 48:129-49
  34. Harrison’s Internal Medicine, 19th Edition, Page 129.

Published on December 3rd, 2017 by under Uncategorized.
Article was last reviewed on January 12th, 2022.

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