What should you know about spotted fever rash?

Spots may be flat, raised, blistered, bruised-looking, itchy, painful, or warm. They may start in one area and spread, or appear with cough, sore throat, vomiting, joint pain, or tiredness. Viral illnesses such as chickenpox, a common cold, or COVID-19 can include fever and skin changes; bacterial illnesses, cellulitis, and other conditions can also be considered. The rash pattern alone cannot identify the cause. Note when the fever began, where the rash started, whether it fades when pressed, and any new medicines, foods, travel, animal, or insect exposure.

Contact a clinician for a new fever with rash, especially in a baby, pregnant person, older adult, or someone with a weakened immune system. Rest, take fluids if able, and use fever medicine only according to the label or a clinician’s advice. Avoid sharing towels and close contact until an infectious cause is considered. Photograph the rash in good light and keep a list of medicines and exposures. Do not scratch blisters or apply steroid, antibiotic, or herbal creams unless advised.

Seek emergency care for a rash that does not fade when pressed, rapidly spreads, looks like bruising, or occurs with severe headache, stiff neck, confusion, fainting, breathing difficulty, facial swelling, or marked drowsiness. Urgent assessment is also needed for dehydration, repeated vomiting, severe pain, or a child who is difficult to wake. Do not wait for the rash to become more obvious if the person is seriously unwell.

Tell the clinician the highest temperature measured, timing and progression of the rash, whether it blanches with pressure, and any cough, sore throat, pain, or breathing change. Mention recent medicines, vaccinations, travel, sick contacts, bites, and underlying conditions.