Clinical Characteristics of Zika Virus Rash

Summary and Comment |
March 16, 2017

Clinical Characteristics of Zika Virus Rash

  1. Rajesh T. Gandhi, MD

Typical features included a widespread micropapular rash, often with pruritus, dysesthesias, and conjunctival hyperemia.

  1. Rajesh T. Gandhi, MD

Clinical manifestations of Zika virus (ZIKV) infection can include fever and rash. However, characteristic features of the rash caused by ZIKV are not completely known. Now, a group has described clinical characteristics of ZIKV exanthema in 60 confirmed cases (31 adults, 29 children) on the Caribbean island of Guadeloupe seen between February 1 and April 29, 2016.

In these patients, rash was widespread, involving a median of 45% of the body surface area. The most common sites of involvement were the face and upper limbs (95% of cases), trunk (93%), and lower limbs (86%); the palms and soles were less frequently involved (30% and 13%, respectively). The rash was typically micropapular (86%); pruritus was frequent (82%) and often intense. The most common mucosal manifestation was conjunctival hyperemia (56%). Dysesthesia occurred in 52% of patients, sometimes accompanied by autonomic symptoms, including dry mouth, heat intolerance, and dry eyes. Low-grade fever was present in 56%.


This descriptive study provides much-needed information regarding the clinical characteristics of Zika virus exanthema. Distinguishing Zika from other arboviral infections is challenging, so more information on clinical clues is helpful. (Although not perfectly discriminatory, severe, disabling arthralgias with high fevers suggest chikungunya; hemorrhagic complications suggest dengue.) Patients with Zika have told me that dysesthesias were one of the more bothersome and distinctive aspects of their infection; this report suggests that both this symptom and itching are relatively common.

Editor Disclosures at Time of Publication

  • Disclosures for Rajesh T. Gandhi, MD at time of publication Grant / Research support Gilead; Roche; EBSCO; Merck; ViiV Editorial Boards UpToDate Leadership positions in professional societies Department of Health and Human Services, Antiretroviral Guidelines for Adults and Adolescents (Scientific Member); HIV Medical Association (Board Member); ID Week (Program Committee); International Antiviral Society-USA (Guidelines Committee)


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