Your child has a viral rash, but which one is it? Here’s a comparison.

Pediatric specialist described different rashes, what they’re likely from

Among the many symptoms of a viral infection is a rash. However, for many families, it’s hard to determine what is causing the rash and how dangerous it is.

SAN ANTONIO – It’s no secret this year has been extreme when it comes to the spread of viruses like flu, RSV and COVID-19, among several others.

These illnesses are hitting kids especially hard.

Among the many symptoms of a viral infection is a rash. However, for many families, it’s hard to determine what is causing the rash and how dangerous it is.

The two most common viral rashes are from the adenovirus and rhinovirus.

“They look kind of like a patchy sunburn all over their bodies. These are just very common viruses that all children get and some adults during this time of year,” said Dr. Dina Tom.

Common viral rash in adults (CDC)

Tom is a pediatric hospitalist at University Hospital and an assistant professor of Pediatrics at UT Health San Antonio.

Tom said it’s not as common, but RSV, flu, and COVID-19 can cause that same type of typical blotchy rash.

“COVID is a different beast altogether. It can also cause some things like COVID toes, COVID fingers. COVID has been known to cause little blood clots, and sometimes those can make some scary-looking rashes,” she said.

People with COVID toes and fingers have a pink or purple swelling in the area, sometimes with a bit of pus under the skin.

COVID fingers (NIH)
COVID toes (NIH)

Tom said it’s always best to get a COVID rash checked out if it persists.

“COVID is new for us,” she said. “Pediatricians are still trying to figure out what’s normal and what’s not normal.”

There is one virus that causes a very specific, identifiable rash.

“It’s a virus called Coxsackie, and it can cause symptoms of basically little ulcers,” Tom said.

It’s commonly known as hand-foot-mouth because that’s where the ulcers form.

Hand-foot-mouth (NIH)

“Ulcers in the back of their mouth, the palms and the soles of the feet, which is rare for most viruses,” Tom explained.

The lesions can look scary, but Dr. Tom said it’s common for most kids to get the virus by age 2, typically from daycare or school.

“It’s self-resolving. There’s no -- doesn’t need antibiotics,” she said.

Hand-foot-mouth rash - CDC (Joel Carillet)

That’s generally the case for most viral rashes, which shouldn’t last longer than a week. You should see a doctor if it keeps spreading or doesn’t go away.

Tom said many viruses cause a high fever. Often, those fevers will go down, and a rash will appear.

“Those rashes can be sometimes a good sign for a pediatrician,” Tom explained.

She said it could mean the virus is leaving the body.

With typical viral rashes, it’s a good sign if you push down and it blanches, meaning it temporarily loses its red or pink color.

Tom said several bacterial rashes are common in the winter.

One is strep, which in many children does not present with a sore throat as it does in adults. It can be a fever or headache, followed by a rash in kids.

The strep rash looks like pink chicken skin on the chest area.

Tom is also currently treating some children with eczema, which was infected by a bacterial staph infection.

“We tend to see eczema in areas that are in between joints, like the elbows or behind the knees, and in the wintertime around their face. So they get this kind of dry, patchy or flaky skin,” Tom said. “It’s almost like chapped lips, but it’s their face. Typically, it’s rough, and it’s sore and kind of itchy.”

Tom said if your child has eczema, pay close attention. If it seems to get worse or turns yellow and puss-filled, it may be because of an added bacterial infection, which can turn serious.

Eczema on back of knees (NIH)

Tom also mentioned a rare situation where a child develops a dark splotchy rash due to an allergic reaction to an antibiotic like amoxicillin. Those reactions are generally termed serum sickness.

However, the splotches begin peeling in extremely rare cases, which can signal a more serious condition.

“It can be hard to tell the difference between serum sickness and Stevens-Johnson syndrome, where it’s basically equivalent of a burn. So the skin can completely slough off or fall off, and that can be very serious,” Tom said. “So definitely important if you if your child’s had recent antibiotics or any other exposure and they’re starting to have this raised rash that’s starting to peel that is not typically normal or should get checked out.”

About the Authors:

Courtney Friedman is a KSAT anchor and reporter. She has an ongoing series called Loving in Fear, confronting Bexar County’s domestic violence epidemic. She's also covered Hurricane Harvey, the shootings in Sutherland Springs and Santa Fe, and tornadoes throughout Texas. She’s a California native and proud Longhorn who loves calling SA home.

William Caldera has been at KSAT since 2003. He covers a wide range of stories including breaking news, weather, general assignments and sports.