Because childhood rashes may be difficult to differentiate by appearance alone, 
it is important to consider the entire clinical presentation to help make the 
appropriate diagnosis. Considerations include the appearance and location of the 
rash; the clinical course; and associated symptoms, such as pruritus or fever. A 
fever is likely to occur with roseola, erythema infectiosum (fifth disease), and 
scarlet fever. Pruritus sometimes occurs with atopic dermatitis, pityriasis 
rosea, erythema infectiosum, molluscum contagiosum, and tinea infection. The key 
feature of roseola is a rash presenting after resolution of a high fever, 
whereas the distinguishing features in pityriasis rosea are a herald patch and a 
bilateral and symmetric rash in a Christmas tree pattern. The rash associated 
with scarlet fever usually develops on the upper trunk, then spreads throughout 
the body, sparing the palms and soles. Impetigo is a superficial bacterial 
infection that most commonly affects the face and extremities of children. 
Erythema infectiosum is characterized by a viral prodrome followed by the 
"slapped cheek" facial rash. Flesh-colored or pearly white papules with central 
umbilication occur with molluscum contagiosum, a highly contagious viral 
infection that usually resolves without intervention. Tinea is a common fungal 
skin infection in children that affects the scalp, body, groin, feet, hands, or 
nails. Atopic dermatitis is a chronic, relapsing inflammatory skin condition 
that may present with a variety of skin changes.