Roseola, also known as Sixth Disease, is a common viral illness that occurs in the pediatric population. Roseola typically affects children 6 months to 2 years of age, though can sometimes affect children outside of these most common age ranges.
Roseola is caused by two common and closely related viruses, human herpesvirus (HHV) type 6 and type 7. While in the same family as herpes simplex virus (HSV), HHV does not cause cold sores and genital herpes which is associated with HSV infections. Roseola is spread by airborne respiratory droplets (coughs and sneezes), saliva (kissing or shared objects), touching contaminated surfaces and/or skin to skin contact.
Roseola is classically noted to cause high fevers (often higher than 103 F) and can last 3-7 days. Associated symptoms can include mild upper respiratory symptoms such as runny nose, congestion and mild cough, diarrhea and decreased appetite. The eyelids can also have a droopy or slightly swollen appearance. When the fever breaks, a classic lacy, erythematous, blanching, (sometimes raised) rash appears on the torso, which then typically spreads to the arms and neck. It may or may not reach the legs and face. The rash is not contagious to the touch, is not typically itchy and can last for several hours to several days before fading on its own. This classic rash and presentation AFTER fever resolves is how we as providers know that roseola is the most common cause for your child’s condition.
Because roseola is caused by a virus, there are no antibiotics used to treat this illness. Instead, we recommend keeping your child as comfortable as possible with symptomatic measures. If your child is 2 months old or greater and has a fever, is fussy or irritable you may treat with Infant/ Children’s acetaminophen (Tylenol) or if your child is 6 months or older, Infant/ Children’s ibuprofen (Advil/ Motrin) is also appropriate. Please check your medication labels or consult with your provider to obtain an appropriate weight-based dose for your child. To prevent dehydration, we recommend aggressive oral hydration and monitoring of urine output. Remember fluids are more important than solids when your child is ill. Your child should have at least 4 wet diapers/ voids in a 24-hour time period. If your child has nasal congestion and/or discharge, you may use saline spray with suction or blowing of the nose along with a cool mist humidifier or exposure to steamy shower.
While roseola is a common and typically mild viral illness, because of associated high fevers, this can put child at risk for a febrile seizure. Febrile seizures occur when the body temperature climbs very quickly, in turn causing convulsions. Each child/ person’s body has a different threshold of when they may have a febrile seizure. Therefore, we recommend when your child has a fever, dress them in lightweight clothing, do not over-bundle and use acetaminophen or ibuprofen as stated above. If your child has a seizure, seek emergency care immediately. Associated febrile seizures, in otherwise healthy children, are generally short lived and are rarely harmful.
Overall, roseola is mild viral illness that we commonly see in pediatrics.
The best prevention to roseola is wash your hands frequently and avoid exposures to infected persons.
As always, if you have questions or concerns regarding the health of your child, consult with your provider for further evaluation.