Roseola (which is sometimes called roseola infantum) is a viral infection. It is quite common and mainly affects young children between the ages of six months and two 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, exanthematous fever and three-day rash. The disease is common in children aged three months to four years, and most common in those aged six months to one year. It is caused by a virus called human herpesvirus 6 (HHV-6). It is a very infectious virus.
The incubation period (the time from infection to symptoms appearing) is between 10 to 15 days. The child is probably infectious during the whole period of the disease and may be even before the high temperature begins.
What are the symptoms of roseola?
- A fever (high temperature) 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 12 to 14 hours.
- 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 is reassuring. It 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.
Make your child comfortable
A fever can make a child feel uncomfortable and irritable. The following 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. Both of these medicines can lower a temperature. You can buy these medicines in liquid form for children. They come in various brand names. An alternative is to give soluble paracetamol in a drink. The dose for each age is given with the medicine packet. Note: these medicines do not treat the cause of the fever. They merely help to ease discomfort. You do not need to use these medicines if the child is comfortable and not distressed by the fever.
Note: do not give both paracetamol and ibuprofen at the same time. However, on occasions, if a fever is difficult to control then, for each time a medicine dose is given, a doctor or nurse may advise alternating one of these medicines with the other. It is best only to do this alternating dose regime after assessment by a doctor or nurse.
Note: do not use ibuprofen for:
- Children known to react (have hypersensitivity) to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
- Children in whom attacks of asthma have been triggered by an NSAID.
- Children with chickenpox. This is because some research has shown that ibuprofen or other NSAIDs may increase the risk of developing serious skin infection complications in children with chickenpox.
- Take the clothes off the child if the room is normal room temperature. It is wrong to wrap up a feverish child. The aim is to prevent overheating or shivering.
- Give lots to drink. This helps to prevent 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 or ibuprofen first. Then, try them with drinks half an hour or so later when their temperature is likely to have come down. If breast-feeding then keep breast-feeding, as breast milk is the best fluid. However, you can offer feeds more often to increase the amount of fluid.
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.
Some people use a fan to cool a child. Again, this may not be a good idea if the fanned air is too cold. However, a gentle flow of air in a room which is room temperature may be helpful. Perhaps just open the window, or use a fan on the other side of the room to keep the air circulating.
Look out for signs of dehydration
A fever caused by any illness may contribute to dehydration (low body fluid). 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. In particular, dehydration can develop more quickly in a child who is vomiting or has a lot of diarrhoea. 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 fever can cause a febrile convulsion (fit). 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 & references
- Lewis LS, Roseola Infantum, Medscape, May 2012
- Mikaeloff Y, Kezouh A, Suissa S; Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft Br J Clin Pharmacol. 2008 Feb;65(2):203-9.
- No authors listed; Varicella, herpes zoster and nonsteroidal anti-inflammatory drugs: serious Prescrire Int. 2010 Apr;19(106):72-3.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Tim Kenny
Dr Beverley Kenny