Child health
AKT · Child health/Infection & rash
Roseola infantum
Human herpesvirus 6 (HHV-6)
Overview
A common viral exanthem of infants (6 months–2 years): several days of HIGH fever, then — as the fever breaks — a rose-pink maculopapular rash. A classic cause of a febrile convulsion.
Recognise
- High fever (often 39–40°C) for 3–5 days in a relatively well child
- Rash appears AS the fever resolves: rose-pink macules/papules on the trunk spreading outward
- Nagayama spots (uvula/soft palate); may trigger febrile convulsions
- Self-limiting
Red flags
- Febrile convulsion; a toxic/unwell child or non-blanching rash (exclude meningococcal sepsis)
Differentials & how to tell them apart
Measlesrash appears WITH ongoing fever + cough/coryza/conjunctivitis + Koplik spots; child looks unwell
Slapped cheek (parvovirus B19)facial "slapped cheek" then lacy rash; less prodromal fever
Scarlet feversandpaper rash, strawberry tongue, sore throat — needs penicillin
Rubellapink rash + suboccipital lymphadenopathy, mild
Investigations
Clinical — the timing (rash AFTER the fever defervesces) is the clue; no tests needed.
Management
Supportive care; reassure — self-limiting
- 1Supportive: antipyretics, fluids, reassurance; safety-net for febrile convulsion and red flags.Gate: A toxic/unwell child or a non-blanching rash → exclude meningococcal sepsis/meningitis, do not attribute to roseola
- 2Febrile convulsion: usually simple and self-limiting; educate parents.
Supportive (antipyretics, fluids) — no antiviral needed
Key points
The discriminator: in roseola the rash appears AS the fever goes and the child perks up; in measles the rash appears WHILE the child is febrile and unwell.
Monitor & prognosis
Resolution within days.
Excellent, self-limiting.
Source: NICE CKS (feverish children); RCPCH