Core Dermatology Diagnoses / CategoriesInfectious

Roseola Infantum

Author: Faculty Reviewer:

Publish date: Posted on
Last updated: October 8, 2021

Keywords #

roseola infantum
exanthema subitum
sixth disease
HHV-6
HHV-7
viral exanthem

Diagnosis #

Roseola infantum isacommon viral exanthem of childhood. Itis characterized by afever followed by a rashupon defervescence.It is typicallycaused by infection with human herpesvirus (HHV) type 6 or 7. The diagnosis is made clinically based upon symptoms and disease progression. The clinical course begins with3-5 days of high fever. As the fever resolves, the exanthem appears,consisting of faintpink, round macules and papules. The lesions are 2-3 mm, blanch, and may coalesce to form patches and plaques.[1-3]

Key Concepts #
  • Roseola follows a classic pattern of high fever followed by a rash. 
  • Commonly affects children under the age of 3. 
  • Caused by HHV-6 or HHV-7.[2] 
  • Roseola is self-limiting and does not require treatment. 
Epidemiology #

Roseola is most commonly seen in children. By the age of 12 months, 50-60% of children will test positively for HHV-6 infection, with numbers over 90% by the age of 3.[4] Most HHV-6 infections are subclinical with only 20% of infected children following the classic clinical course. Reactivation may occur, typically in immunosuppressed hosts.[5]

Clinical Features #
  • Roseola commonly occurs in children before the age of 3. 
  • The infection typically begins with a febrile stage lasting 3-5 days, with fevers often greater than 40°C.[6] 
  • As the fever resolves, a pink, morbilliform rash appears, beginning on the trunk, that can spread to the extremities, neck, and face. 
  • The rash can resolve in a matter of hours to days with no sequelae. The most common complication is febrile seizures.[7] 
Differential Diagnoses #
Diagnostic Workup #

No diagnostic workup is indicated for roseola as it is considered a clinical diagnosis. Serologic testing can confirm the presence of HHV-6 or HHV-7.[8] 

Treatment #

No treatment is indicated, as roseola is self-limited and self-resolving.

References #
  1. Stone RC, et al. “Roseola infantum and its causal human herpesviruses.” International Journal of Dermatology, vol. 53, no. 4, 2014, pp. 397–403. 
  2. Yamanishi K, et al. “Identification of human herpesvirus-6 as a causal agent for exanthem subitum.” Lancet, vol. 331, no. 8594, 1988, pp. 1065-7. 
  3. Berenberg W, Wright S, Janeway CA. “Roseola infantum (exanthem subitum).” The New England Journal of Medicine, vol. 241, 1949, pp. 253-9. 
  4. Huang LM, et al. “Primary infections of human herpesvirus‐7 and herpesvirus‐6: a comparative, longitudinal study up to 6 years of age.” Acta Paediatrica, vol. 86, no. 6, 1997, pp. 604–8. 
  5. Razonable RR. “Infections due to human herpesvirus 6 in solid organ transplant recipients.” Current opinion in organ transplantation, vol. 10, no. 6, 2010, pp. 671-5. 
  6. Caserta MT, et al. “Primary human herpesvirus 7 infection: a comparison of human herpesvirus 7 and human herpesvirus 6 infections in children.” The Journal of pediatrics, vol. 133, no. 3, 1998, pp. 386-9. 
  7. Hall CB, et al. “Human herpesvirus‐6 infection in children. A prospective study of complications and reactivation.” The New England Journal of Medicine, vol. 331, no. 7, 1994, pp. 432-8. 
  8. Ward KN. “The natural history and laboratory diagnosis of human herpesviruses‐6 and ‐7 infections in the immunocompetent.” Journal of clinical virology, vol. 32, no. 3, 2005, pp. 183-93. 
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