What Is a Maculopapular Rash?

A red skin rash with both raised and flat areas

Table of Contents
View All
Table of Contents

A maculopapular rash is a red rash that has both flat areas and bumps. It typically covers a large patch of skin and is associated with childhood viruses like rubella and scarlet fever. Maculopapular rashes can also be due to allergic reaction, an autoimmune disease, HIV, or another cause.

A maculopapular rash does not necessarily itch, but if it does, your healthcare provider may prescribe a cream to ease the sensation. Depending on the cause, you may need other treatment as well.

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

What a Maculopapular Rash Looks Like

A maculopapular rash is a mix of flat discolored areas of skin (macules) and small raised bumps (papules). These rashes are described by the Greek word exanthem, which means "a skin eruption that bursts forth or blooms."

This photo contains content that some people may find graphic or disturbing.

viral maculopapular rash

DermNet / CC BY-NC-ND

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

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

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 of the most notable causes of maculopapular rashes include:

  • Measles
  • Rubella
  • Scarlet fever
  • Hand, foot, mouth disease
  • Allergic reactions
  • Drug reactions
  • Autoimmune disease
  • Skin conditions
  • Environmental causes
  • HIV

Measles

A maculopapular rash is a classic symptom of measles, along with high fever, cough, and red, watery eyes.

The rash usually appears three to five days after the other symptoms. 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 appear to fuse together.

Rubella

Rubella is a common childhood virus also known as German Measles. A person will develop a maculopapular rash on their face roughly two weeks after infection with the rubella virus. Then the rash spreads down to their feet.

This rash stands out from the standard measles rash because it is milder, and the small spots that characterize it aren't interconnected like they are with measles.

The maculopapular rash the rubella virus causes normally lasts about three days and can appear stronger after a warm bath/shower or engaging in any other activity that causes the body to become overheated.

Scarlet Fever

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

In this case, 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. 

Hand, Foot, and Mouth Disease

Hand, foot, mouth disease is usually mild and mostly affects children 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.

Allergic Reactions

If you suddenly develop a maculopapular rash, it may be an allergic reaction. 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.

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.   

Skin Conditions

A maculopapular rash is a common symptom of certain skin conditions. These include:

Environmental Causes

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

HIV

Maculopapular rashes are associated with HIV, the virus that causes AIDS.

People with HIV 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.

When to See a Healthcare Provider

Because maculopapular rashes can have varying causes, you should see a healthcare provider for any rash that comes on suddenly, covers all or most of your body, or is accompanied by fever.

A rash that blisters can be serious and should be immediately evaluated by a healthcare provider.  

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 and do a physical exam.

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

A Word From Verywell

If you develop a maculopapular rash, contact a healthcare provider to be evaluated. If you can't see a physician promptly, 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.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Evaluation of maculopapular rash. Evaluation of maculopapular rash - Differential diagnosis of symptoms | BMJ Best Practice. https://bestpractice.bmj.com/topics/en-us/774.

  2. Kang JH. Febrile Illness with Skin RashesInfect Chemother. 2015;47(3):155–166. doi:10.3947/ic.2015.47.3.155

  3. Altman K, Vanness E, Westergaard RP. Cutaneous Manifestations of Human Immunodeficiency Virus: a Clinical UpdateCurrent Infectious Disease Reports. 2015;17(3). doi:10.1007/s11908-015-0464-y

  4. Drago F, Ciccarese G, Gasparini G. Contemporary infectious exanthems: an updateFuture Microbiology. 2017;12(2):171-193. doi:10.2217/fmb-2016-0147

By Heather L. Brannon, MD
Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.