What is Roseola?

Roseola Infantum - Sixth Disease

Roseola infection or erythema infectiosum on the torso of a 6 month old baby. Copyright: Dr. Susan J. Huang

Roseola infantum (sixth disease), more commonly known as roseola, is a common rash in children that's caused by human herpes viruses 6 and 7 (HHV-6 and HHV-7). The infection is so common almost 100% of adults around the world test positive for the antibodies, meaning they've been infected in the past. Even though it's very rare for the infection to cause any permanent damage, the rash can look like other more serious rashes.

Roseola Transmission

Roseola is transmitted in respiratory droplets. The virus stays around in the body like other herpes viruses, so most adults shed the virus without knowing it.

A child can come in contact with these respiratory droplets if:

  • he comes in direct contact with saliva or mucus from an infected person, like when someone shedding the virus kisses her
  • someone near her sneezes or coughs into the air and she breathes in some of the droplets
  • she wipes her nose or mouth after touching something that was just touched by a person who coughed or sneezed into his hand

Roseola Infection

After someone comes in contact with HHV-6 or HHV-7, the virus starts to invade. It enters the bloodstream, triggering the immune system to begin to fight it off. Antibodies neutralize the virus, but the virus doesn't go away. It becomes dormant and retreats to different sites in the body.

The virus doesn't usually reactivate, but it can in a person who is immunosuppressed, such as someone with HIV.

Roseola Symptoms

The first symptom of roseola is a high fever. Though the fever can get as high as 104 or 105 degrees, an infant or young child might have only mild fatigue and irritability. This fever can last from 1 to 8 days, though 3 to 4 is typical.

In addition to the fever, the child may also have swollen lymph nodes (especially in the back of the neck), tonsillitis, diarrhea, and vomiting.

Some children may have seizures; roseola is a common cause of febrile seizures. However, seizures are rare. If they do occur, they are almost always due to the fever and not due to viral infection of the brain.

As the fever finally breaks, the rash starts. The rash consists of rose-colored spots that start on the trunk and spread to the face and extremities. If you push on one of the spots, the color fades and then comes back when you release pressure. The rash doesn't itch, and the spots don't join together. It is common for a child to not have any rash at all with roseola, or for the rash to last only a couple of hours. The rash can last up to 2 days.

Roseola Diagnosis

A doctor will look for the typical features of the infection to diagnose roseola. Sometimes a blood count is done when the child has a high fever, but the results are typical for a viral infection.

Roseola Treatment

For otherwise healthy children with roseola, there is no specific treatment to kill the virus. It's helpful to treat the fever with Tylenol (acetaminophen) or Advil (ibuprofen), but never aspirin.


Mancini AJ and A Shani-Adir. “Other Viral Diseases.” Dermatology, 2nd Ed. Eds. Jean Bolognia, and et. al. Mosby, 2008. 1222-3.

Wolfrey JD, et al. "Pediatric Exanthems." Clinics in Family Practice. 5(2003): 568-573.

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