Describe the rubella rash pattern.

• A. Maculopapular rash beginning at face and spreading downward
• B. Vesicular rash on palms and soles
• C. Petechial rash on trunk
• D. Urticarial rash all over body

Answer: (A)

Rubella causes a maculopapular exanthem that begins on the face and spreads downward (craniocaudal progression) to the trunk and limbs. This pattern is classic for rubella: a pink, fine rash that appears on the face and moves to the body over a short time, often with accompanying posterior cervical or suboccipital lymphadenopathy. The rash is not vesicular, so a vesicular pattern on palms and soles would point to other infections such as hand-foot-and-mouth disease. It is also not petechial or purpuric, which would suggest hemorrhagic or purpuric conditions, nor urticarial, which would imply an allergic or drug-related reaction.