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This is a common rash of children and young adults, thought to be caused by a virus. There may be a mild preceding illness (prodrome) of fever, fatigue, joint pains, and sore throat, these symptoms are rare. The first sign of the illness is the appearance of a single round or oval "herald patch" anywhere on the body. This first patch can be from 1/2 to 4 inches in diameter. It is ring-like, with a scaly border; it is usually misdiagnosed as ringworm.
About 5-10 days later, there is a widespread eruption, usually over the trunk but sometimes spreading to the extremities. These spots are smaller ovals, less than 1/2 inch in diameter; they are raised, flat, pink to brown, and develop a fine scaly texture. These smaller lesions tend to align with the long axis along skin fold lines, giving the classic "Christmas tree" distribution; once seen, not forgotten.
Treatment is unnecessary for most patients. Lotions help the scaling. Itching can be treated with a lubricating lotion containing menthol and camphor or by an oral antihistamine such as diphenhydramine (Benadryl®), especially at night for more restful sleep. Hydrocortisone cream may be necessary to alleviate itching. After the rash has resolved, the skin may have either lighter or darker pigmentation, particularly in black patients; these changes eventually disappear (but this may take weeks to months).