Roseola

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Theory 
Diagnosis 
Management 
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Last reviewed: 30 Apr 2025

Last updated: 26 Oct 2022

Roseola is a common febrile viral illness of early childhood; it is usually caused by human herpesvirus (HHV)-6B and occasionally by HHV-7.

Roseola is characterized by 3 to 7 days of fever, often high grade (>103.0°F [39.5°C]), followed by onset of a diffuse morbilliform rash that appears with defervescence of fever. The lesions are discrete 3- to 5-mm pink-red macules and papules that commonly begin on the neck and trunk and spread to the extremities.

Roseola is usually a benign self-limited illness that has been associated with febrile seizures.

Definition

Roseola (also called exanthem subitum or sixth disease for the sixth classic pediatric exanthem) is a common early childhood febrile illness, characterized by 3 to 7 days of high fever followed by onset of rash that appears with resolution of fever. The rash consists of asymptomatic pink-red macules and papules. Febrile seizures may occur. Roseola is most commonly caused by human herpesvirus (HHV)-6B, but occasionally by HHV-7 and rarely by other viruses. HHV-6A (associated with thyroiditis), HHV-6B (roseola), and HHV-7 (roseola) are lymphotropic viruses within the Herpesviridae family and Betaherpesvirinae subfamily, and all establish latency. HHV-6A, HHV-6B, and HHV-7 can occasionally integrate into the host chromosome. Reactivation of the roseola viruses may occur with immunosuppression.

History and exam

Key diagnostic factors

age under 2 years
immunosuppression
high fever
exanthem

Full details

Other diagnostic factors

diarrhea
abdominal pain
Nagayama spots
tympanic membrane inflammation
upper respiratory symptoms
seizures
periorbital edema
bulging anterior fontanelle
cervical, occipital, or postauricular lymphadenopathy

Full details

Risk factors

age under 2 years
immunosuppression

Full details

Diagnostic tests

1st tests to order

no initial test

Full details

Tests to consider

viral culture
antibody detection

Full details

Emerging tests

polymerase chain reaction (PCR)
immunohistochemistry

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Henry M. Feder, Jr., MD

Professor of Pediatrics and Family Medicine

University of Connecticut Medical Center and Connecticut Children’s Medical Center

Farmington

Disclosures

HMF declares that he has no competing interests.

Hassan El Chebib, MD

Attending Physician in the Division of Infectious Diseases and Immunology

Connecticut Children’s Medical Center

Assistant Professor of Pediatrics

Pediatrics, Infectious Diseases and Immunology

University of Connecticut School of Medicine

Hartford

Disclosures

HEC declares that he has no competing interests.

Ashley C. Howard, DO

Attending Physician in the Division of Infectious Diseases and Immunology

Connecticut Children’s Medical Center

Assistant Professor of Pediatrics

Pediatrics, Infectious Diseases and Immunology

University of Connecticut School of Medicine

Hartford

Disclosures

ACH declares that she has no competing interests.

Acknowledgements

Dr Henry M. Feder, Dr Hassan El Chebib, and Dr Ashley C. Howard would like to gratefully acknowledge Dr Edward C. Kim, Dr Nicholas Bennett, Dr James Azim, Dr Margie C. Andreae, Dr Jon Dyer, and Dr Jennifer Holman, the previous contributors to this topic.

Disclosures

ECK, NB, JA, MCA, JD, and JH declare that they have no competing interests.

Peer reviewers

Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed

Consultant Paediatrician

Heartlands Hospital

Birmingham

Disclosures

HG declares that she has no competing interests.

Mary T. Caserta, MD

Associate Professor of Pediatrics

Department of Pediatrics

Division of Infectious Diseases

University of Rochester Medical Center

Rochester

Disclosures

MTC declares that she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kimberlin DW, Barnett ED, Lynfield R, et al. Human herpesvirus 6 (including roseola) and 7. In: Red Book: 2021–2024 report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021.

Braun DK, Dominguez G, Pellett PE. Human herpesvirus 6. Clin Microbiol Rev. 1997;10:521-67.Full text Abstract

Hall CB, Long CE, Schnabel KC, et al. Human herpesvirus-6 infection in children: a prospective study of complications and reactivation. N Engl J Med. 1994 Aug 18;331(7):432-8.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Measles
- Enterovirus
- Epstein-Barr virus
More Differentials
Guidelines
- Viral exanthems
- Human herpesvirus 6 (including roseola) and 7
More Guidelines
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Roseola

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

all patients

Contributors

Authors

Henry M. Feder, Jr., MD

Disclosures

Hassan El Chebib, MD

Disclosures

Ashley C. Howard, DO

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed

Disclosures

Mary T. Caserta, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice