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Posted by Dr. Monica Wonnacott | September 30, 2016

Roseola: The Common Fever Then Rash Illness

Roseola is practically a rite of passage in early childhood. It seems like one of those bugs that everyone gets, so it’s worth knowing what to do…might save you a trip to the doctor. So here’s the scoop:

What is Roseola?

Roseola, also called sixth disease (back in the day when diseases got numbered) or Roseola Infantum is an illness characterized by fever then rash. It is usually caused by the Human Herpes virus 6, but can be caused by the Human Herpes virus 7. Now don’t freak out when you hear herpes, it’s not the same strain that causes cold sores and genital warts (but yes, in the same family). It’s a benign illness that kids recover from completely. It is classically an illness of really young children (in that 6 months to 2 years mark), but has been documented in patients as old as 18. It doesn’t seem to be a bug that kids get over and over (although it is possible). It’s generally a one and done bug.

What are Roseola symptoms?

The most notable symptoms are the high fever and rash with Roseola. The trick is that the fever comes first, breaks, and then the rash appears. In Roseola, the fever and rash are never at the same time (or it’s not Roseola). When I was in med school, I always remembered Roseola as the illness where the rash “blooms” like a rose after the fever. There are often other associated symptoms, but they are mild. So the child may be irritable, have a slight runny nose or slight cough. Occasionally there is mild diarrhea. It is worth reiterating that the fevers are typically quite high (in the 103-105 range). When the rash appears, it is pink, raised or flat, spotty, and most notable on the trunk. The rash isn’t on the palms or soles. Also, the rash isn’t bothersome to the child; it isn’t itchy or usually noticed by the child.

How is Roseola diagnosed?

The diagnosis is a clinical one. Your pediatrician will take a good history, do a physical, and then make the call. Lab work is not usually done or necessary. Technically, the diagnosis can’t be made until the rash appears. Previous to that (in the fever stage), it’s speculation that a child has Roseola.

Is there a treatment or cure?

There is no cure and no vaccine to prevent it. The best way to prevent getting it is staying away from sick people and good hand hygiene. Treatment is completely supportive. If the child has a fever, treat it with Tylenol or Motrin to make the child feel better. There are no creams or medicines that need to be used for the rash (since it’s viral in nature).

How long does Roseola last?

The fever component typically lasts anywhere from 2-5 days (average is 3). Once the rash appears, it takes a couple of days to clear up. I have had patients that have had small amounts of rash still faintly present up to a week afterwards.

Is Roseola contagious?

Yes, Roseola is contagious. It is contagious in the fever stage. However, once the rash breaks out (which is often when the kid actually physically looks the worse), the child is no longer contagious. It is one of the most common reasons I write notes allowing patients to go back to daycare (because the rash scares daycares). The bug is passed through respiratory/oral secretions (through cough droplets, saliva, snotty noses, etc.).

Do I need to go to the doctor?

The general short answer is no. There is nothing that the doctor can do to hasten the healing process or make it better. You should go to the doctor if the fever is prolonged (and no rash) or you aren’t certain of the diagnosis. Otherwise, it’s one of those benign little illnesses that you could save your time and money and skip the doctor on this one.

Thanks to my cute patient’s mom who allowed me to snap a pic of her child yesterday in clinic to show you the classic Roseola rash.