Assessment of maculopapular rash

Last reviewed: April 2018

Last updated: May 2018

Summary

The patient with an acute maculopapular rash presents a diagnostic challenge to the clinician. The term maculopapular is non-specific, as many eruptions have a primary morphology of macules or papules, and the term may be mis-used to indicate any rash. The term rash is itself also non-specific and is sometimes incorrectly applied to any skin finding; eruption may be preferred for a cutaneous reaction of acute onset. However, the term maculopapular rash is in common clinical usage and will be retained here for purposes of simplicity. Synonyms for maculopapular rash include exanthematous eruption (exanthem) or morbilliform eruption.

Definitions

The term maculopapular rash typically implies an acute and generalised eruption.

Morphological terms:

Macule: a flat skin lesion <1 cm in greatest diameter. When macules exceed 1 cm, the appropriate term is patch.
Papule: a raised bump <1 cm in diameter. When papules exceed 1 cm in size, the appropriate term is plaque (palpable lesions elevated above the skin surface) or nodule (a larger, firm papule with a significant vertical dimension).

Other morphological terms encountered in this clinical setting include:

Pustule: a papule containing purulent fluid
Vesicle: a papule containing clear serous fluid
Bulla: a larger vesicle >1 cm
Urticaria: a wheal or hive.

Hence, the term maculopapular rash implies a skin eruption of flat and raised lesions.

Differentials

Common

Allergy to food or drug
Insect bites or stings
Adverse drug reaction to, e.g., antibiotic, anticonvulsant, or allopurinol
Chemotherapy
Enterovirus and echovirus infection
Fifth disease (erythema infectiosum)
Roseola infantum (sixth disease)
Epstein Barr virus (EBV) infection (infectious mononucleosis)
Cytomegalovirus (CMV) infection

Full details

Uncommon

Iodinated contrast media non-immediate adverse reaction
Erythema multiforme major (toxic epidermal necrolysis or Stevens-Johnson syndrome)
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Erythema multiforme
Systemic hypersensitivity syndrome
HIV-seroconversion exanthema
Acute hepatitis B virus infection
Acute hepatitis C virus infection
Rubella (German measles)
Rubeola (measles)
Meningococcaemia
Scarlet fever
Staphylococcal scalded skin syndrome
Toxic shock syndrome (Staphylococcus exotoxin)
Rocky Mountain spotted fever or Mediterranean spotted fever
Acute graft-versus-host disease (aGVHD)
Kawasaki disease (mucocutaneous lymph node syndrome)
Juvenile-onset or adult-onset Still disease
Syphilis (secondary)
Ebola virus infection
Zika virus infection
Chikungunya virus infection
Dengue fever

Full details

Contributors

Authors VIEW ALL 

Adelaide A. Hebert, MD

Professor & Director of Pediatric Dermatology

Department of Dermatology and Pediatrics

UTHealth McGovern Medical School Houston

Houston

Disclosures

AAH declares that she has no competing interests

Mary DarConte, MD

Clinical Research Fellow

Department of Dermatology

University of Texas Health Sciences Center in Houston

Houston

Disclosures

MD declares that she has no competing interests.

Acknowledgements

Dr Adelaide A. Hebert and Dr Mary DarConte would like to gratefully acknowledge Dr Mark Naftanel and Dr Hobart W. Walling, previous contributors to this topic. MN and HWW declare that they have no competing interests.

Peer reviewers VIEW ALL 

Brian Swick, MD

Clinical Assistant Professor

University of Iowa College of Medicine

Iowa City

Disclosures

BS declares that he has no competing interests.

Kimberly Schulz, MD

Dermatologist

Town Square Dermatology

Coralville

Disclosures

KS declares that she has no competing interests.

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Assessment of maculopapular rash

Summary

Definitions

Differentials

Common

Uncommon

Contributors

Authors VIEW ALL 

Adelaide A. Hebert, MD

Disclosures

Mary DarConte, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Brian Swick, MD

Disclosures

Kimberly Schulz, MD

Disclosures

Patient leaflets

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