Roseola (Sixth Disease) Symptoms, Treatment & Pictures

Roseola is a benign viral illness found in infants and characterized by high fevers that last 3 or 4 days, followed by defervescence and development of a macular or maculopapular rash


  • Exanthem subitum
  • Sixth disease
  • Roseola infantum
  • Pseudorubella
  • Human herpesvirus 6 (HHV-6), human herpesvirus 7 (HHV-7)



  • Typically the child develops a high fever, usually up to 104° F (40° C), that lasts for 3 to 5 days
  • Fever may be associated with a runny nose, irritability, and fatigue
  • A rash appears within 48 hr of defervescence, begins on the neck or trunk and then spreads to extremities, and persists for a few hours to 2 days.
  • Faint pink maculopapular rash that blanches when palpated and generally nonpruritic
  • Other common findings: cervical and/or occipital adenopathy, erythematous tympanic membranes, anorexia
  • Nagayama spots: red papules on the soft palate or base of the uvula
  • Seizures
  • Less common: febrile seizures (≤6% of cases), cough, diarrhea, aseptic meningitis


  • Roseola is usually caused by human herpesvirus- 6 (HHV-6) in the great majority of cases but other causes include human herpesvirus- 7, enteroviruses, adenoviruses, and parainfluenza virus type 1. A small percentage of children may have primary infection with HHV-7.
  • The incubation period is between 5 and 15 days.


The diagnosis of roseola is usually made by the clinical presentation as stated previously. It can be confirmed serologically by  indirect immunofluorescence assays, ELISA, neutralization assays, and immunoblot. Viral culture is the gold standard to document active viral replication but is expensive, time consuming, and available only in research laboratories.


  • Rubeola (measles)
  • Rubella
  • Fifth disease (erythema infectiosum) caused by parvovirus B19
  • Enteroviral infections
  • Drug eruption
  • Mononucleosis
  • All causes of fever (e.g., otitis media, pneumonia, and urinary tract infection)
  • Meningitis


  • If unsure of the diagnosis of roseola in a febrile infant, a fever workup is done to rule out other infectious causes.
  • The decision to proceed with a fever workup is a clinical judgment call.


  • CBC with differential usually shows relative neutropenia and mild atypical lymphocytosis.
  • Erythrocyte sedimentation rate (ESR), blood cultures as indicated
  • Urinalysis and urine cultures
  • Stool cultures if diarrhea is present
  • Lumbar puncture if needed to rule out meningitis in patients with mental status changes
  • Commercial assays can be used to detect HHV-6-specific IgG antibody responses but IgM assays are not always reliable for acute Infection


Chest x-ray to rule out pneumonia.



  • Supportive care
  • Maintain hydration by drinking clear fluids: water, fruit juice, lemonade, and so forth
  • Sponge bathe with lukewarm water if febrile


  • Acetaminophen 10 to 15 mg/kg per dose at 4-hr intervals for fever
  • Ibuprofen 5 to 10 mg/kg per dose at 6-hr intervals (maximal dose 600 mg)


Roseola is a viral disease that is short lasting; chronic treatment is usually not an issue.


  • Complications, although rare, can occur and include:
  1. Febrile seizures
  2. Meningitis
  3. Encephalitis
  4. Pneumonitis
  5. Hepatitis

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