What Is a Maculopapular Rash?

A maculopapular rash is a mix of macules (flat discolored areas of skin) and papules (small raised bumps) that usually covers a large area of skin. It may appear red or pink if your skin is light, or darker than your natural tone if your skin is dark.

This type of rash is associated with childhood viruses like rubella and scarlet fever, but can also be due to an allergic reaction, an autoimmune disease, HIV, or another cause.

If it itches, your healthcare provider may prescribe a cream to ease the sensation. Depending on the cause of your maculopapular rash, you may need other treatments as well.

This article covers the various causes of maculopapular rashes, when to see a healthcare provider, and how they will work to diagnose and treat you.

What a Maculopapular Rash Looks Like

As you can see in this picture of a maculopapular rash, these rashes:

• Are red with flat and raised areas
• Have areas where small bumps may merge together
• Cover a large area of skin
  

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Sometimes these rashes are associated with dryness and itching around the affected area.

When viruses or bacteria are to blame, a person with a maculopapular rash will also develop symptoms such as fatigue or muscle aches.

Causes of Maculopapular Rash

Maculopapular rashes are associated with many medical conditions. Some causes of maculopapular rashes include:

Allergic Reactions

This type of rash appears shortly after you've been exposed to something you're allergic to. Since such a reaction may become life-threatening, you should seek medical attention at once.

Skin Conditions

A maculopapular rash is a common symptom of eczema, psoriasis, and contact dermatitis (allergic skin reaction).

Drug Reactions

A maculopapular rash that develops four to 12 days after starting a new medication may be a drug reaction. When this happens, you may also have symptoms like muscle pain and a low-grade fever.

If you experience this after taking a new medication, contact your healthcare provider right away.

Autoimmune Disease

Cutaneous lupus erythematosus is an autoimmune condition that affects the skin. One of the symptoms is a maculopapular rash.  

Environmental Exposures

Things you might encounter outdoors, such as bug bites and excessive heat, can cause maculopapular rashes in some people.

Hand, Foot, and Mouth Disease

This infection is usually mild and mostly affects children age 5 and under. The associated maculopapular rash typically appears on the palms of the hands and soles of the feet.

Other symptoms include sores in the mouth, fever, sore throat, and loss of appetite.

Measles

Early symptoms of measles include high fever, cough, and red, watery eyes. The rash usually appears three to five days after the other symptoms appear.

It may start as flat red spots on the face that spread down to the rest of the body. Small bumps may appear on top of the flat ones, and the spots may look like they are fused together.

Rubella

Also known as German measles, this common childhood virus causes a maculopapular rash on the face roughly two weeks after infection. The rash then spreads down to the feet.

Scarlet Fever

This infection is caused by the same bacteria that causes strep throat. It usually begins with a sore throat and fever. A maculopapular rash typically appears a day or two after the other symptoms.

The rash tends to first appear on the neck, groin, or underarms before spreading to the rest of the body. A scarlet fever rash typically has very fine bumps that may feel like sandpaper. 

HIV

People with HIV, the virus that causes AIDS, may break out in a maculopapular rash on the upper part of their bodies two to six weeks after exposure to the virus. This is part of acute retroviral syndrome, the flu-like symptoms that newly infected individuals sometimes exhibit.

The rash may resolve after a couple of weeks.

Diagnosis

If you have a maculopapular rash, your healthcare provider will ask you a series of questions about your medical history (including vaccination status), allergies, and medications you might be taking.

You will likely also be asked if you've been exposed to someone with a rash-causing illness or if you have traveled to a place where certain viruses are common.

Your healthcare provider will also ask about any other symptoms you may be experiencing. A rash accompanied by fever and diminished energy, for example, can indicate an infection.

You will also get a full physical examination that includes a close look at your skin. Sometimes the characteristics of a maculopapular rash can help identify the cause.

For example:

• A rash all over the body is likely to be caused by an infection or exposure to something you consumed, like food or medication. A rash in a very localized area is more likely to be caused by contact dermatitis.
• The rubella rash stands out from the measles rash because it is milder and involves small spots that do not interconnect. The rash caused by the rubella virus normally lasts about three days and can appear worse after a warm bath/shower or engaging in any other activity that causes the body to become overheated.

Blood or urine tests can help with diagnosis. In some cases, a biopsy (a small skin sample taken for examination under a microscope) can also be helpful.

Maculopapular Rash Treatment

The treatment for a maculopapular rash includes therapies to ease symptoms and address the underlying cause. If there is a concern about anaphylaxis, you will immediately be treated with epinephrine.

Tylenol (acetaminophen) or another fever-reducer may be given. Fluids may be recommended if you're dehydrated due to an infection.

Sometimes a topical lotion or ointment may be recommended or prescribed for comfort. Allergic rashes or rashes due to an environmental cause may also be treated with a topical anti-inflammatory or topical steroid. Systemic steroids or non-steroidal anti-inflammatories (NSAIDs) may be recommended or prescribed in some situations.

A rash that is caused by an infection may be treated with antibiotics if the infection is bacterial. Viral infections are not treated with antibiotics, and sometimes they are treated with an antiviral medication.

If your rash is caused by a medication, skin contact, allergen, or environmental factor, you will be advised to avoid the causative substance.

Summary

A maculopapular rash is a common type of rash that occurs with a variety of different medical conditions, infections, and exposures. This rash can be itchy or uncomfortable, but it is usually treatable. In some cases, it will simply go away on its own.

The diagnosis is often made with consideration of timing, exposures, other symptoms, and physical examination. In some instances, diagnostic tests are needed, too.

A Word From Verywell

If you develop a maculopapular rash, contact a healthcare provider to be evaluated. If you can't get a prompt appointment, make a trip to an urgent care facility, as some causes of maculopapular rashes need immediate treatment.

Physicians receive training to distinguish between rash patterns, but if they're unclear which medical condition is causing the rash, they may take a swab to have it identified, get a blood sample to look for antibodies to viruses or bacteria, or conduct DNA probes to find the rash-causing agent.