Itchy Rash Puzzles Health Officials

From the WebMD Archives

Feb. 28, 2002 -- From Arizona to West Virginia, school kids are itching -- and no one seems to know why. In the last five months, health officials in 14 states have reported mysterious rashes in elementary school children, according to a CDC report released today.

Since the first rash was reported in Indiana last October, patterns of rashes have popped up in Arizona, Connecticut, Florida, Georgia, Mississippi, New York, Ohio, Oregon, Pennsylvania, Texas, Virginia, Washington, and West Virginia.

In Connecticut, one school was closed for a day so classrooms could be cleaned, air-handling units checked, and air filters replaced. Five Pennsylvania schools have also been examined for some sort of environmental contamination. "But none of these inspections have shown anything," says John P. Maher, MD, MPH, director of health for Chester County, Penn.

The CDC is working with state and local health and education agencies to determine if there is a common cause, the report says.

Fifth disease -- the name given to a rash caused by parvovirus B19 -- is the most commonly identified condition associated with children's rashes. It's a mild facial rash, looking much like a "slapped cheek," says the CDC. The itchy rash spreads to the trunk and limbs and usually lasts no longer than 10 days. Kids usually have a low-grade fever, feel sluggish, possibly sniffling and sneezing.

But most public health officials say that it isn't fifth. "Most children have tested negative," Maher tells WebMD. Various other tests have been run, but no pattern has emerged, he says.

"Some of the newspapers have mentioned the possibility of a totally new virus," says Maher. "Right now we don't think that's true." What they do wonder -- if it's a variant of B19. "State health officials are working with a researcher on that right now."

Luckily, the rash "has been mild and self-limited, and kids are really not very sick," he says. In some cases, parents are resisting getting kids tested just because it's so mild.

Still, it's not been a fun winter for some kids. Among the cases cited in the CDC report:

In Indiana, 18 cases involving third-grade students in one school were reported in a one-month period last fall. In most cases, the rash began on the face, then spread to the upper extremities -- a reddish, welt-type itchy rash that caused swollen eyes and pink cheeks.

In Pennsylvania, 575 cases in 58 schools and child-care centers have been reported. Mostly girls have had the itchy, bright-red, sometimes burning rashes. Among the first 54 cases, children were tested for parvovirus; 10 cases were positive. Some came back positive for a different virus. Environmental causes have been investigated, but results are pending.

In Oregon, rashes were reported in 53 children and 11 adults (84% were female) in one elementary school, and in 84 children and seven adults in a middle school since Feb. 4. The rash, which appeared on cheeks and arms, was itchy and had a sunburned appearance.

In Connecticut, nine elementary children had rashes on Feb. 20. The next day, 16 fourth-graders in one school also reported a similar rash. The rash appeared on the trunk and extremities and lasted no longer than 72 hours.

In trying to diagnosis the rash, doctors have attributed it to eczema, chemical exposure, and poison ivy.

However, "with 53 million young people attending 117,000 schools each school day in the United States, it is expected that rashes from a wide range of causes will be observed," the report says.

Maher agrees that it's nothing to get worked up over.