The rash appears 2 to 4 days after the patient first becomes ill with fever. On the first day of rash a few raised spots called papules appear. They are usually seen first on the face, and subsequently on the body and extremities. On the right side of this picture, a few small papules may be seen. Unless it is known that the patient has been exposed to the virus or in contact with a smallpox case two weeks before, one may not suspect the diagnosis at this time.