What to know about blueberry muffin rash in babies

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The term “blueberry muffin rash” was coined in the 1960s. During this period, many babies contracted rubella while in the womb.

In babies who acquire rubella while in utero, the disease can cause a distinctive rash that presents as small, purplish, blister-like spots on the skin. The rash resembles the appearance of a blueberry muffin.

Certain other infections and health disorders besides rubella may also lead to blueberry muffin rash.

If a baby develops blueberry muffin rash or any other type of rash, a parent or guardian should speak with a doctor.

Congenital rubella syndrome (CRS) is an infection passed on to an unborn baby while they are in the womb. It occurs if the pregnant person acquires rubella during pregnancy.

Rubella infection is most dangerous to the unborn baby during the first trimester, or the first 12 weeks, of pregnancy.

If a person contracts rubella during this time, it can lead to serious congenital abnormalities in their child, including developmental delays, congenital heart disease, and cataracts. After 20 weeks, the risk of these complications decreases.

In the United States, rubella infection is rare. Vaccinations eliminated the disease in 2004. However, imported cases of rubella can still occur due to international travel.

Rubella is a viral infection that causes a rash. Often, this rash first appears on the face before spreading to other areas of the body.

In older children and adults, the rash may appear red on light skin and a darker color on dark skin.

In babies who acquired rubella in the womb, the rash can appear as small, blueish bumps that resemble a blueberry muffin.

While the term may have originated in the 1960s to describe rubella symptoms, other conditions can also result in a blueberry muffin-like rash. These include:

• congenital infections, such as herpes, syphilis, HIV, chlamydia, Epstein-Barr, cytomegalovirus (CMV), and toxoplasmosis
• twin-to-twin transfusion syndrome
• alloimmunization, which is an immune response in the baby from pregnancy
• metabolic disorders
• certain blood disorders
• congenital vascular disorders

As a result, if a baby presents with a rash, parents or guardians should have them looked at to rule out other possible causes.

This section includes some pictures of blueberry muffin rashes in babies.

A parent or guardian should contact a doctor if a baby develops a rash that:

• appears as blue or purple raised dots on the skin
• does not go away after a few days
• has corresponding symptoms, such as fever or swollen glands

A parent or guardian should also contact a doctor again if any new symptoms appear or if the existing symptoms do not go away or get worse.

In older children and adults, a rubella rash will appear as a red, pink, or darker rash that starts on the face and spreads to the rest of the body. A person should contact a doctor if they suspect rubella.

People who have recently given birth or are pregnant and suspect rubella exposure should also see a doctor. They may recommend testing the person, the baby, or both for rubella or other potential conditions.

Rubella can cause additional symptoms.

The first signs of infection can include:

• fever
• cough
• runny nose
• headache
• swollen lymph nodes
• mild pink eye (redness or swelling of the white of the eye)

The rash will typically develop on the face and then spread to other areas of the body.

However, 25–50% of people with rubella may never display symptoms of the infection. And a person can still transmit rubella even if they do not have symptoms.

A person should contact a doctor if they suspect they might have come in contact with rubella.

Rubella is an airborne disease, which means it spreads from person to person via droplets in coughs and sneezes.

However, a pregnant person can also pass it on to an unborn baby, which causes congenital rubella. Children born with rubella are considered contagious for up to 1 year following birth.

A person with rubella may be contagious for up to 7 days before and after a rash appears.

If a person has rubella, they should contact their friends, family, school, and workplace to notify others that they may have caught the infection.

Learn more about how rubella spreads.

When rubella appears in children, doctors typically recommend a combination of rest and drinking lots of fluids. The goal of treatment is to ease symptoms.

The infection will typically heal on its own in 5–10 days. A child should avoid contact with other children for 7 days after developing the rash.

CRS can cause congenital abnormalities that are incurable. A healthcare professional can offer advice on managing congenital abnormalities in a baby.

If another underlying cause is responsible for the blueberry muffin rash in babies, a doctor will recommend treatments based on the cause.

Doctors do not use medication to treat rubella or congenital rubella syndrome.

Rubella is unlikely to occur in the United States due to the high level of vaccination against the infection. However, a person can still contract it during international travel, and if they are unvaccinated.

In children and adults, symptoms of rubella are generally mild. A rubella rash should go away in about 5–10 days.

However, rubella is dangerous to a fetus during the first trimester of pregnancy. If a person contracts rubella during this time, it can lead to congenital abnormalities, stillbirth, or miscarriage.

If a baby with CRS is born with congenital abnormalities, a parent or guardian may need to help address their needs during their lifetime.

To reduce the risk of contracting rubella, a person should get vaccinated before becoming pregnant and avoid foreign travel to areas where rubella is still present.

The best prevention for rubella is to get vaccinated with the measles, mumps, and rubella (MMR) vaccine. A person should discuss vaccination with a doctor.

In the United States, children typically get two doses on the following schedule:

• dose 1: between 12 and 15 months old
• dose 2: between 4 and 6 years of age

Children may get an MMR vaccine earlier than 12 months if they are traveling internationally, but they still must receive the two-dose series according to the routine schedule when they return.

A parent or guardian should have an unvaccinated child avoid anyone with a known rubella infection for at least 7 days following the start of their infection.

There is no evidence that the MMR vaccine causes autism.

Diagnosis of rubella typically starts with a review of the baby’s symptoms and medical history.

After reviewing symptoms and history, the doctor will likely perform a physical examination. In some cases, they may be able to use the unique look of a blueberry muffin rash to make a diagnosis of congenital rubella in a baby.

If not, they can order blood tests to check for rubella or other possible causes of the rash if rubella is not suspected.

A rubella rash in older children and adults will look different. A person should contact a doctor if they develop a red, pink, or darker rash on their face that spreads to their body. A doctor can examine the rash and make a diagnosis.

“Blueberry muffin rash” is a term first used in the 1960s to describe a rash resulting from congenital rubella syndrome. CRS occurs in babies when a pregnant person passes rubella to them in the womb.

Vaccines eliminated rubella in the United States, but an unvaccinated person can still contract it, often from foreign travel.

In the United States, children receive two doses of the MMR vaccination. If a child does not receive the vaccination, they can contract rubella from exposure to a person who has the condition.

The rash typically goes away on its own within a week. A person is still contagious for up to 7 days following the start of their rash.