What is roseola? How do you treat it?

Endless coughs and sneezes, runny noses, and unexplained itchy bumps—kids seem to be a magnet for germs. In our parent’s guide to childhood illnesses, we talk about the symptoms and treatments for the most common conditions. Read the full series here.

What is roseola? | Symptoms | Diagnosis | Treatments | Prevention

Roseola was the first illness I faced as a new parent beyond the odd sniffles. My then 13-month-old son spiked a sudden fever in the afternoon, but otherwise seemed perfectly fine. It would be a few days before the rash appeared and we learned that while the fever was scary, it wasn’t dangerous. The cause of the fever was a common and usually harmless childhood illness: roseola.

What is roseola?

Roseola (sometimes called sixth disease or roseola infantum in babies) is a common illness in childhood that is characterized by a high fever followed by a rash. “Most children have been infected with roseola by the time they start kindergarten,” says Soma Mandal, MD, a board-certified internist at Summit Medical Group in Berkeley Heights, New Jersey.

Roseola is contagious for children and adults, but because most people experience it in childhood and gain immunity, it is rare for adults to catch it.

“Roseola can be caused by different viruses, but the most common cause is a virus called human herpesvirus 6,” Dr. Mandal says. “Typically, this occurs from asymptomatic shedding of the virus in secretions of close contacts.” Another, less common, virus that can cause roseola is human herpesvirus 7. 

Roseola typically occurs in children younger than 2 and is most contagious while the child has a fever for three to five days, before the rash appears. Although measles, rubella, fifths disease (parvovirus), and roseola all present with rashes, they are distinct illnesses from each other.

“Roseola is spread by droplets when an infected person, speaks, coughs or sneezes and then it gets on the mucous membranes (eyes, nose, and mouth) of the recipient of the infection,” says Leann Poston, MD, a medical contributor for Ikon Health.

Roseola is rarely serious. Occasionally, the fast-rising high fever caused by roseola can cause a febrile seizure or aseptic meningitis, which will resolve. While these seizures are scary for parents, they are rarely serious and not associated with epilepsy or other seizure disorders. Febrile seizures occur in about 10% to 15% of young children who have roseola.

Roseola symptoms

“In some people, the infection causes very few to no symptoms,” says Dr. Poston. For those who are symptomatic, symptoms can include:

A high fever (usually between 101 degrees F and 105 degrees F) that often comes on suddenly, lasts three to five days, then suddenly goes away. Some children have a runny nose, cough, or sore throat before developing a fever.

A pinkish-red rash that may or may not be slightly raised that appears as the fever goes away (12 to 24 hours later). The rash starts on the trunk and spreads to the neck, arms, legs, mouth, and face. The rash lasts one to three days, or for just a few hours.

The roseola rash typically has the following characteristics:

• Pinkish-red in color
• May be flat or raised
• Starts on the trunk and usually spreads to other areas
• Spots turn white when touched
• Individual spots might have a lighter “halo” around them
• Lasts from a few hours to a few days

Some children with roseola behave normally and appear to feel well, despite the high temperature. Most children feel well by the time the rash appears. Other symptoms include:

• Swollen lymph nodes, especially in the head or neck
• Mouth sores
• Decreased appetite
• Irritability
• Ear pain
• Swelling of the eyelids
• Swollen glands
• Mild diarrhea

An important note: Descriptions of rashes are usually characterized by how they look on light skin. Skin conditions may look different on darker skin. Photos of rashes available both online and in medical schools tend to show the rash on light skin. More research and resources are needed to help parents and healthcare professionals recognize what these rashes look like on darker skin.

How is roseola diagnosed?

Roseola is diagnosed based on symptoms. Because symptoms of roseola can be similar to other illnesses, it’s a good idea to get a proper diagnosis from a family healthcare provider or pediatrician.

See a healthcare provider within 24 hours if:

• The fever comes back.
• The rash gets worse.
• You think the child needs to be examined, but it’s not urgent.

See a healthcare provider immediately if:

• There are large blisters on the skin.
• The child looks or acts very sick.
• You think the child needs to be examined, and it’s urgent.

Call 911 immediately if:

• The rash becomes purple or blood-colored with fever.
• You think your child has a life-threatening emergency.

How to treat roseola in children

In most cases, roseola will resolve on its own and there is no treatment, but there are some ways you can make your child feel better. Treatment for roseola is the same as for high fevers from other viruses. It can include:

• Fever-reducing medications such as acetaminophen (Tylenol) or ibuprofen (Advil/Motrin). Do not give ibuprofen to babies younger than six months old unless advised by a healthcare provider. Never give children Aspirin as it can be life-threatening when combined with a viral illness.
• Dress the child in lightweight clothing.
• Keep the child hydrated with breast milk, formula, water, popsicles, Pedialyte, and other clear fluids.

Do not try to reduce a fever with an icy or cold bath. And never use alcohol rubs. This is ineffective and dangerous.

Antibiotics will not work for roseola because it is a viral infection, not caused by bacteria. In rare cases, antivirals, such as foscarnet or ganciclovir may be prescribed to children with roseola if they have weakened immune systems. These medications are dosed by age and weight, and must be given under the supervision of a healthcare provider.

Of course, a little TLC (tender loving care) goes a long way when little ones aren’t feeling well. Let the child rest, and give lots of reassurance if they feel yucky. Since illnesses that cause fever can be contagious, it’s wise to keep your child away from other children, at least until you’ve conferred with his or her provider. Once the fever is gone for 24 hours, even if the rash is present, your child can return to child care or preschool, and resume normal contact with other children. Your provider may need to write a note for your child to return to school. 

Roseola prevention

Most people do not get roseola more than once. Like chicken pox and other herpes family viruses, the HHV-6 and HHV-7 viruses stay in the system for life. While they usually stay dormant, they can reappear and cause fever and infection in the lungs or brain if a person’s immune system becomes weakened (through disease or medication), but this is very rare.

There is no known way to prevent roseola other than basic good hygiene practices such as handwashing, covering sneezes and coughs, and keeping healthy children away from infected children. There is no vaccine for roseola.

While roseola is very common and most children will contract it, it is comforting for parents to know it is usually harmless and goes away on its own.