Roseola is a viral infection. It is quite common and mainly affects young children between the ages of 6 months and 2 years. It is usually a mild infection that causes no long-term problems. Full recovery is usual.
What is roseola?
Roseola is also known as roseola infantum, sixth disease and three-day rash. The disease is common in children aged 3 months to 3 years and most common in those aged 6 months to 2 years. It is usually caused by a virus called human herpesvirus type 6 (HHV-6). It may also be caused by human herpesvirus type 7 (HHV-7).
The time from infection to symptoms appearing (the incubation period) can be from 9 to 15 days. The child is probably infectious during the whole period of the disease and may be even before the high temperature (fever) begins. It is a very infectious virus.
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What are the symptoms of roseola?
- A high temperature (fever) suddenly develops. The child can be flushed, irritable, and unwell with the fever. The temperature can be as high as 40°C. The fever typically lasts 3-4 days and then drops quickly back to normal.
- A rash usually appears when the fever subsides, when the child is getting better. Small pink spots appear. They usually start on the body and then spread to the arms and legs. The rash does not usually develop on the face. The rash usually lasts for about 1-2 days.
- A sore throat may develop and the child may go off their food.
- Some glands in the neck may swell.
Roseola is often diagnosed when the child is getting better. At first the high fever may cause concern to parents and doctors if it is not clear what is causing it. Other more serious illnesses may need to be ruled out. The sudden drop in fever and the appearance of the typical rash are reassuring. This indicates that the fever has been caused by the roseola virus and nothing more serious.
What is the treatment for roseola?
There is no treatment that kills the virus. Treatment aims to keep the child as comfortable as possible until the illness goes.
Dealing with a high temperature (fever)
A fever can make a child feel uncomfortable and irritable. There are things that you can do that may bring the temperature down and make your child feel more comfortable.
You can give paracetamol or ibuprofen to lower a temperature. You can buy paracetamol and ibuprofen in liquid form, or as melt-in-the-mouth tablets, for children. It comes in various brand names. The dose for each age is given with the medicine packet. These medicines do not treat the cause of the fever. They merely help to ease discomfort caused by the fever. They also ease headaches, and aches and pains. You do not need to use these medicines if your child is comfortable and does not have a fever.
If one of these medicines on its own is not enough to keep the temperature down, you can use both. For example, if the effect of paracetamol is wearing off but it is too soon to give another dose, you could then use ibuprofen. Do not use more than advised on the packet or bottle. Do not use ibuprofen in children in whom attacks of asthma have been triggered by ibuprofen in the past.
Keep your child cool. Take extra layers of clothes off your child if the room is normal room temperature. Use light cotton clothes or bedding. Open windows or use a fan in the room where appropriate. Do not cold-sponge a child who has a fever. This used to be popular but it is now not advised. This is because the blood vessels under the skin become narrower (constrict) if the water is too cold. This reduces heat loss, and can trap heat in deeper parts of the body. The child may then get worse. Many children also find cold-sponging uncomfortable.
Give lots to drink. This helps to prevent a lack of fluid in the body (dehydration). You might find that a child is more willing to have a good drink if they are not so irritable. So, if they are not keen to drink, it may help to give some paracetamol first. Then, try the child with drinks half an hour or so later when his/her temperature is likely to have come down.
Look out for signs of dehydration
A fever caused by any illness may contribute to dehydration. The fever itself can cause more sweating, and some children who become irritable with a fever do not drink as much as they might need. Encourage your child to have plenty to drink if they have a fever. Signs of dehydration include: a dry mouth, no tears, sunken eyes, drowsiness and generally becoming more unwell. Seek medical help if you suspect that your child is becoming dehydrated.
Are there any complications from roseola?
Sometimes the high temperature (fever) can cause a fit (febrile convulsion). This can be alarming but is usually not serious. Other reported complications are very rare. Full recovery is normally expected.
Once a person has had this condition then they will be immune from having it again.
Further reading and references
Roseola; DermNet NZ
Wolz MM, Sciallis GF, Pittelkow MR; Human herpesviruses 6, 7, and 8 from a dermatologic perspective. Mayo Clin Proc. 2012 Oct87(10):1004-14. doi: 10.1016/j.mayocp.2012.04.010. Epub 2012 Jul 21.
Stone RC, Micali GA, Schwartz RA; Roseola infantum and its causal human herpesviruses. Int J Dermatol. 2014 Apr53(4):397-403.
Allmon A, Deane K, Martin KL; Common Skin Rashes in Children. Am Fam Physician. 2015 Aug 192(3):211-6.
Mullins TB, Krishnamurthy K; Roseola Infantum (Exanthema Subitum, Sixth Disease)