Maculopapular Rash

Unless you’re in the medical field, you shouldn’t be surprised if you have never before heard the term “maculopapular rash”. It’s not something that people hear about often, unless they work for a health care provider.

“Maculopapular” is a compound word made from two terms, and these are “macule” and papule”. Macules are flat discolorations or blemishes that measure smaller than 1 centimeter. Papules are elevated lesions that also measure smaller than 1 centimeter. When these two terms are combined, you can determine that maculopapular rashes are those that are composed of redness or smooth skin rash, with elevated bumps.

Other terms that mean the same type of formation include exanthematous eruption (sometimes called exanthema) and morbilliform eruption.

How does a maculopapular rash appear when found on the body?

Since they do involve inflammation, these types of rashes appear as reddened skin (also called erythematous). They may be concentrated in a relatively small area on the body, or they can cover more of the body, if they become generalized.

This type of rash may be:

  • Acute – lasting less than four weeks
  • Subacute – lasting for four to eight weeks
  • Chronic – lasting more than eight weeks

In children, this rash is generally caused by viral infection. In adults, the cause is usually allergies or drugs.

Maculopapular rash may be associated with various other factors, as well. If you don’t also have a fever, this rash may not be a significant problem. However, if you’re febrile, and also have other symptoms, it can be a sign of disease. It should not be ignored.

Maculopapular Rash Photographs

article-1-pic-1Maculopapular Rash on a 14 month old’s back – probably resulted as a complication of an infection from Epstein Barr Virus.

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article-1-pic-2Maculopapular rash on an HIV patient

article-1-pic-3Maculopapular rash in H1N1 patient

article-1-pic-4Maculopapular rash of a man who also had severe diarrhea

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article-1-pic-5A maculopapular rash occurring after a case of otitis media

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article-1-pic-6Erythematous-related maculopapular rash

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article-1-pic-7Maculopapular rash

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article-1-pic-8Maculopapular rash located on the trunk

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Classification of Maculopapular Rash Causes

Causes related to Infection

  • Infectious Mononucleosis

This type of infection affects adolescents and older children. The accompanying morbilliform rash may be visible on the arms and trunk.

  • Parvovirus B19 (also called Fifth Disease or Erythema Infectiosum)

This disease commonly infects children between the ages of three and 12 years. The maculopapular rash associated with this disease is usually bright red, and the skin may appear as though it has been slapped. The skin coloring is caused by the fever that generally occurs before the rash appears.

  • Chikungunya Virus (also known as Dengue)

Itchiness and redness of the skin may precede maculopapular rash in cases of dengue. The rash typically spreads to the limbs and face from the trunk. Petechiae is also sometimes noted in these cases.

  • Roseola (also called Exanthema Subitum)

Roseola occurs in children under the age of three years. The rash in these cases is scattered on the body, with the face often being unaffected. The rash itself appears only after the fever has run its course.

  • Rubeola (commonly called measles)

It is common for children with the measles to experience maculopapular rash. It appears first behind their ears and then extends to their hairline, along with the extremities and trunk.

Once the rash has become brownish and has come off in flakes or scales, the measles is nearing its end. The earliest rash fades first, followed by the next rash that appeared, and the next, until all rash areas have faded. The clustered white lesions called Koplik’s spots usually disappear just after the rash appears.

  • Rubella (also known as German Measles)

The maculopapular rash brought on by Rubella begins first on the face, before it starts spreading downward on the body.

Other Causes of Maculopapular Rash

  • Cytomegalovirus (CMV)
  • Rickettsia rickettssi (also known as Rocky Mountain Spotted Fever)
  • Enteroviruses
  • Epstein-Barr Virus (EBV)
  • Borrelia burgdorferi (often called Lyme disease)
  • Treponema pallidum (Secondary Syphilis)
  • Rickettsia typhi (Murine Typhus)
  • Rickettsia prowazekii (Louse-Borne Typhus)
  • Chlamydia psittaci (Psittacosis)
  • Salmonella typhi (also known as Typhoid Fever)
  • Spirillum minus (sometimes called Rat-Bite Fever)
  • Streptobacillus moniliformis (Rate-Bite Fever)
  • Ehrlichia and Anaplasma (Ehrlichiosis)
  • Leptospira (Leptospirosis)
  • Drug Eruptions

Medications including allopurinol, antibiotics and anticonvulsants may have side effects of maculopapular rash. In a research project with 50,000 patients on these types of drugs, 91% of drug eruptions were maculopapular eruptions. Some other risk factors include female gender, immunosuppression and advanced age.

Maculopapular rash is known to be a delayed-cell mediated or type IV reaction, brought about by the body’s hypersensitivity to a certain medication or its metabolite.

If you start a new medication and develop maculopapular rash within four to 12 days of the day you started the drug, it should be suspected as a side effect of that drug. Confirmation occurs if you discontinue taking the drug and then the rash disappears within a specific time period. If your physician has you re-start the medication in question, the rash will re-appear. An alternative drug should be selected.


Insect stings or bites or food allergies may cause the appearance of maculopapular rash . It will begin soon after the food is ingested or the insect has bitten or stung you.

Rheumatologic & Systemic Diseases

These diseases may have maculopapular rashes as a symptom:

  • Still’s disease, also known as juvenile rheumatoid arthritis
  • Kawasaki disease, also called mucocutaneous lymph node syndrome
  • Acute diseases of grafts-versus-hosts, in bone marrow or stem cell transplants

Maculopapular Rash in HIV Patients

HIV positive patients may have this rash as an early sign of that virus. It is a primary HIV infection occurring on any part of your body, but particularly common on the palms of the hand, face and trunk. Maculopapular rash in the genital area or mouth may pose as ulcers. The rash may last between two and three weeks.

Maculopapular Rash in Children

The main causes of maculopapular rash with children are viral skin rash eruptions such as those associated with:

  • Cytomegalovirus (CMV)
  • Epstein-Barr virus (EBV)
  • Roseola
  • Parvovirus B19
  • Rubella
  • Rubeola
  • Adenoviruses

The Diagnostic Approach to Maculopapular Rash

The diagram below may be of help to physicians, in determining causes of this rash. It guides the user on the proper way to proceed in order to provide patients with proper treatment.

Flow Chart for Diagnosis of Maculopapular Rash


Maculopapular Rash – The Diagnostic Approach

Photo Source: Fleisher GR & Ludwig S, Textbook of Pediatric Emergency Medicine

If a patient has maculopapular rash, the first thing to do is ascertain whether or not he has a fever. If he does, then he should be checked for other symptoms of disease.

If a patient has this rash, along with a fever and appears ill, he may have one of these illnesses:

  • Ehrlichiosis
  • Rocky Mountain Spotted Fever
  • Kawasaki disease
  • Dengue
  • Rubeola
  • Erythema multiforme

If a patient has the rash and fever but doesn’t appear to be ill, they may have one of these issues:

  • Secondary syphilis
  • Roseola infantum
  • Mycoplasma infection
  • Epstein-Barr virus
  • Drug-induced rash
  • Gonorrhea
  • Varicella
  • Scarlet fever
  • Erythema infectiosum
  • Coxsackie virus
  • Viral infection

If a patient has a rash and no fever, determine whether the rash is localized or generalized. If it is localized, the rash may have been caused by:

  • Papular acrodermatitis
  • Scabies
  • Insect bite(s)
  • Contact dermatitis

If the rash is generalized, without a fever, determine whether it is chronic or not. If it is chronic in nature, the patient may be suffering from:

  • Papular urticarial
  • Pityriasis lichenoides
  • Lichen nitidus
  • Molluscum contagiosum

If the rash is acute in nature, the patient might have one of the following:

  • Secondary syphilis
  • Scabies
  • Rubella
  • Mycoplasma infection
  • Insect bite(s)
  • Guttate psoriasis
  • Drug-related rash
  • Pityriasis rosea
  • Erythema multiforme
  • Erythema infectiosum
  • Contact dermatitis
  • Another viral infection

Maculopapular Rash – Differential Diagnosis

This type of rash may mistakenly be referred to as a pustule, vesicle, plaque, nodule, patch, papule or macule. These skin lesions can be differentiated from one another with the use of these photographs:

article-1-pic-12Macule is smaller than 1 cm. The appearance is flat, like freckles.

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article-1-pic-13Patches are like enlarged macules. They measure greater than 1 cm

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article-1-pic-14A papule, like a macule, is smaller than 1 cm. Unlike a macule, it is elevated, not flat.

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article-1-pic-15A nodule is a round-ish elevation of the skin and measures greater than 1 cm. If it exceeds 2 to 3 cm in size, it has become a tumor.

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article-1-pic-16A plaque is larger than 1.5 cm. The edges are elevated with lesions and the middle is flat. Psoriasis is one example of a plaque.

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article-1-pic-17Vesicles (see the green arrows) and bulla (see the red arrow) both have fluid within them. They are elevated and rounded. The main difference between vesicles and bulla is their size. Vesicles are smaller than 1 cm and bullae are greater than 1 cm in size.

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article-1-pic-18Pustules are lesions containing pus.

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Here is a “mnemonic” about Maculopapular rash.

Treatment for Maculopapular Rash

If a patient’s maculopapular rash was caused by a reaction to drugs, discontinue them unless their benefits outweigh the side effects. In patients with penicillin allergies, avoid the use of cephalosporins and carbapenems.

If a patient’s reaction is caused by an allergy to radioactive medium, use a histamine H2-receptor antagonist, ephedrine & diphenhydramine or prednisone before introducing the radioactive medium.

The existence of maculopapular rash alone is not considered a medical condition on its own. Eliminating the cause will help in getting rid of it. The treatment is largely symptomatic.

For patients with infectious diseases: Rest, proper hygiene, oral hydration, IV infusion, antivirals or antibiotics will be required. If they are experiencing discomfort, oral antihistamines and topical corticosteroids may be helpful. Treatment plans can also include UV and gamma radiation. Patients who have HIV or another advanced condition will require specialized care.


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