Roseola

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Roseola facts

  • Roseola is a mild viral illness most commonly of young children.
  • Roseola is a common viral infection.
  • Roseola is also termed sixth disease, roseola infantum, and exanthema subitum.
  • A sudden high fever that lasts for three to five days is an early feature of roseola. Mild nasal congestion and loose stools may accompany the fever.
  • When the fever disappears, a rash appears, which may last one to two days.
  • The rash of roseola is not contagious.
  • Roseola usually resolves without any treatment.

What is roseola? Is roseola contagious?

  • Roseola is a mild contagious illness caused by either one of two viruses. Characteristically, roseola has a sudden onset and relatively short duration.
  • Roseola is most common in children 6-24 months of age, with the average age of 9 months. Less frequently, older children, teens, and (rarely) adults may be infected.
Picture of the roseola rash
Picture of the roseola rash; SOURCE: Fitzpatrick's Dermatology in General Medicine. Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell. Seventh Edition. Copyright 2008, 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All rights reserved.

Quick GuideCommon Childhood Skin Disorders

Common Childhood Skin Disorders

Roseola Symptoms and Signs

Roseola is a mild viral illness of childhood. It is characterized by high fever that typically comes on suddenly and lasts for three to five days. Other symptoms of roseola are mild nasal congestion, eye redness, and a rash that appears after the fever has resolved.

What virus causes roseola?

Roseola is primarily caused by a virus called human herpesvirus 6 (HHV-6) and less frequently by human herpesvirus 7 (HHV-7).

What are the risk factors for roseola?

Many studies have shown that the large majority of those infected with the HHV-6 or HHV-7 virus have no obvious symptoms. Their immune system clears the virus prior to the development of any symptoms. For those individuals who do develop an overt infection, the vast majority sustain no side effects. The rare individual with a compromised immune system may be at risk for a more complicated course of disease. This would include newborn infants (first six to eight weeks of life), individuals receiving chemotherapy, or those with illness that impacts the immune system (such as HIV-AIDS).

How is roseola spread? What is the incubation period for roseola?

  • Roseola is spread from person to person, typically by transfer of oral secretions.
  • The incubation period between exposure to the virus and onset of symptoms is nine to 10 days.
  • Humans are the only natural hosts for HHV-6 and HHV-7.
  • Unlike some other viral infections, roseola occurs throughout the year without seasonal variation.

What are roseola symptoms and signs?

The signs and symptoms of HHV-6 (or HHV-7) infection vary depending upon the age of the patient.

  • Infants and toddlers routinely develop sudden symptoms with an abrupt onset of a high fever (103-104 degrees) that lasts for three to five days.
  • The child may also develop irritability, swollen glands in the front or back of the neck, runny nose, puffy eyelids, and mild diarrhea.
  • Within 12-24 hours of the fever breaking, a rash rapidly appears.
  • Older children who develop HHV-6 (or HHV-7) infection are more likely to have an illness characterized by several days of high fever and possibly a runny nose and/or diarrhea.
  • Older children less commonly develop a rash as the fever abates.

What specialties of doctors treat roseola?

Pediatricians and family practitioners are capable of diagnosing and managing a child with roseola. Specialists (infectious disease experts) are rarely needed to assist in the care of this generally benign disease.

How do health care professionals diagnose roseola?

The characteristic clinical pattern of sudden onset of high fever and development of the typical rash at the time of fever resolution generally enables a rapid diagnosis without any laboratory studies. For unusual presentations, patients with complications or those with immune deficiency states, several forms of blood tests can assist in establishing the diagnosis.

How high can the fever go with roseola?

The fever can be quite high. The fever averages 103.5 F (39.7 C), but it can go up as high as 106 F (41.2 C).

What are home remedies for roseola?

Since roseola patients experience a moderate fever, medications to lower fever (antipyretics) are helpful in lowering fever and lessening any associated discomfort (such as headache). Such medications include acetaminophen and/or ibuprofen. A cool bath (approximate water temperature of 85 degrees) may also be therapeutic. No therapy is necessary regarding the rash of roseola since it does not cause symptoms, it is short-lived, and it resolves spontaneously.

What is the treatment for the fever of roseola?

If the fever is not causing the child to be uncomfortable, the fever need not be treated. It is not necessary to awaken the child to treat a fever unless instructed to do so by a health care professional.

If someone wants to treat the fever, acetaminophen (Tylenol and others) can be used. The dosage interval is every four hours. Ibuprofen (Advil, Motrin, and others) may be used in lieu of acetaminophen on an every six-hour basis. Both families of medication are equally effective in lowering a child's fever. There is no medical benefit alternating acetaminophen with ibuprofen. Aspirin should never be used for fever in children or adolescents.

A child with a fever should be kept comfortable and not be overdressed. Overdressing can cause the temperature to go higher. Bathing with tepid water (85 F or 29.5 C) may help bring down a fever by 1 to 1.5 degrees. If a child develops shivering during the bath, the temperature of the bath water should be raised. Never sponge a child (or an adult) with alcohol; the alcohol fumes may be inhaled, causing many problems.

Quick GuideCommon Childhood Skin Disorders

Common Childhood Skin Disorders

What should one do if his or her child with roseola has a seizure?

The hardest thing to do is to keep calm while helping the child to the floor and loosening any clothing around the neck. Remove any sharp objects that could cause injury, and turn the child on one side so saliva can flow from the mouth. Putting a cushion or a folded coat under the head for a pillow is fine, but do not put anything in the child's mouth. The best thing is just to wait it out. Most febrile seizures (whether associated with roseola or other viruses) last less than five minutes. Do not leave the child unattended while calling the paramedics of the doctor's office. Children are often drowsy and sleep after a seizure. That is normal. After the seizure, contact the child's health care professional to determine if the child should be immediately examined.

Can the fever cause a seizure?

Yes. The sudden and rapid rise in temperature elevation may trigger a seizure (a convulsion). Febrile seizures (convulsions due to fever) are common (3%) in children between 18 months to 3 years of age. They occur in 5%-35% of children with roseola.

Is a seizure due to fever dangerous?

The seizure may look very frightening, but it is usually quite harmless (benign). Febrile seizures are not associated with long-term nervous-system side effects or brain damage. Anticonvulsant medications are very rarely prescribed for the treatment or prevention of febrile seizures.

Is there a rash with roseola?

Yes, but not in the beginning. When the fever disappears, a rash appears. The rash is mainly located on the neck and torso (the abdomen, trunk, and back), but it can also be on the arms and legs (extremities).

The rash may appear as separate little raised ("goose bump" size) dots (papules) or as a flat (macular) rash. The skin is often mildly red in color and temporarily blanches with pressure. The rash is not itchy or painful. It is not contagious. The rash lasts one to two days and does not return.

What is most remarkable characteristic of roseola?

What is most striking is that the child seems so well despite having a high fever.

How long does roseola last?

The fever of roseola lasts three to five days followed by a rash lasting about one to two days that resolves without treatment. Immunity to HHV-6 seems to be lifelong.

Are there any complications of roseola?

Complications are rare with roseola except in children with suppressed immune systems. Individuals with healthy immune systems generally develop lifelong immunity to HHV-6 (or HHV-7).

Should a child with roseola see a doctor?

Yes, an evaluation by a health care professional is a good idea. A child with a fever and a rash should not go back to child care until they are medically evaluated.

When can the child return to child care?

A child with just the rash of roseola and no fever for 24 hours can usually return to child care.

Quick GuideCommon Childhood Skin Disorders

Common Childhood Skin Disorders

Is there a vaccine for roseola?

At this time, there is no vaccine for roseola. Due to its generally benign nature and rare rate of complications, many researchers doubt that the high financial cost to develop such a new vaccine would be worthwhile.

Is it possible to prevent roseola?

The primary mechanism for HHV-6 or HHV-7 transmission is via human-to-human respiratory droplet secretions. Therefore, basic hand-washing and avoidance of acutely ill individuals (such as those with fever) is the best way to avoid contracting the illness. Day care centers and preschools should follow routine principles of hygiene and decontamination of toys and articles shared by their children.

What is the prognosis for a child with roseola?

With the exception of immune-compromised patients, the prognosis for a child with roseola is excellent and no long-term side effects should occur.

Are there other names for roseola?

Roseola is referred to by a number of other names. It was formally called roseola infantum or roseola infantilis. Because the rash appears so suddenly (right after the fever dramatically departs), the disease is commonly called exanthem subitum.

To distinguish roseola from other childhood diseases featuring skin rashes, it was once dubbed "sixth disease" (because it was the sixth disease young children typically developed, and it lasted about six days). But that name has largely been forgotten.

REFERENCES:

American Academy of Pediatrics. Pickering, L.K., C.J. Baker, D.W. Kimberlin, and S.S. Long, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009.

Tremblay, Cécile, and Michael T. Brady. "Roseola Infanatum (Exanthema Subitum)." June 2017. UpToDate.com.

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Reviewed on 8/4/2017
References
REFERENCES:

American Academy of Pediatrics. Pickering, L.K., C.J. Baker, D.W. Kimberlin, and S.S. Long, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009.

Tremblay, Cécile, and Michael T. Brady. "Roseola Infanatum (Exanthema Subitum)." June 2017. UpToDate.com.

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