Roseola can affect anyone of any age, including adults. Those who have never been infected or are immunocompromised are at higher risk of infection.

Roseola — also known as sixth disease — is a contagious illness caused by a virus. Roseola usually manifests as a fever followed by a distinctive skin rash of pink patches or spots.

Most cases of roseola occur in childhood and are not serious. Adults can still be infected, especially if they didn‘t have roseola as a child. People with a compromised immune system may also experience a reactivated roseola infection.

Roseola treatment is pretty straightforward. It includes resting, taking anti-inflammatory medications, and making sure to drink plenty of water.

This article explains what roseola looks like, how long it’s contagious, and what you can do to treat the infection.

Roseola is most often caused by human herpesvirus 6, which has an incubation period of around 9-10 days. However, some children may show symptoms sooner. It’s also possible to be infected with this virus and not develop any symptoms at all.

Per the National Health Service (NHS) and the Centers for Disease Control and Prevention (CDC), common symptoms of roseola include:

  • high fever
  • rash (often not itchy)
  • runny nose
  • sore throat
  • eyelid swelling
  • swollen lymph nodes
  • loss of appetite

There is no specific test that can be used to diagnose roseola, although sometimes a blood test can identify its antibodies. Doctors usually diagnose roseola based on fever and the rash.

Roseola fever

A high fever usually comes before the skin rash in roseola. The fever can reach 104°F (40°C) and last 3 to 5 days. Roseola is contagious during this time.

A signature rash usually develops within 12 to 24 hours after the fever has gone away.

Learn more: How to treat your baby’s fever.

Roseola rash

Rash appearance may differ slightly depending on how much melanin is in your skin. This skin rash is usually red or pinkish, and may be flat or raised. Its pattern can look like splotches or dots.

The roseola rash is usually not itchy.

The rash usually starts on the abdomen and then spreads to the face, arms, or legs. The appearance of the rash is usually a sign that the virus is at the end of its course. Most people are not contagious by this stage.

Learn more: Everything you need to know about roseola rash.

Roseola is a viral illness that is usually caused by exposure to the human herpesvirus (HHV) type 6 or 7. Roseola outbreaks can occur at any time of the year, but the most common peaks occur in spring and fall.

Like many other viruses, roseola is commonly spread through small droplets of fluid. These droplets can move from one person to another with a cough, sneeze, or even from talking in close contact.

The incubation period — how long it takes to get sick after exposure — for roseola is usually 9 or 10 days.

This means a child with roseola who hasn‘t yet developed symptoms can easily spread the infection to another child during this time, even if they don’t appear sick.

Roseola is no longer contagious by the time the illness has entered the rash stage, which is almost always after the fever.

Roseola leads to febrile seizures in about 15 percent of children with the infection due to high fever.

According to the National Institutes of Health (NIH), signs of febrile seizures can look like:

  • twitching or jerking movements
  • loss of consciousness
  • eyes rolling back into the head

If your child experiences any kind of seizure, they should be evaluated by a doctor right away. Febrile seizures may reoccur but are not known to cause any long-term damage or health issues.

In very rare cases, roseola can lead to other serious health complications, including:

There is no vaccine for roseola, and it spreads like many common colds.

Symptoms can mimic a simple head cold or not appear at all. This makes it difficult to know if someone has the virus and should be avoided and quarantined.

Since most roseola infections occur in young children, it can help to:

  • Keep your child home if they are not feeling well.
  • Wash you and your child’s hands frequently.
  • Teach your child to use tissues and then wash their hands, or cough and sneeze into their elbow.
  • Avoid sharing cups or utensils with others, and encourage your child to do the same.
  • Clean and disinfect high touch surfaces regularly (like doorknobs or railings).
  • Clean and disinfect toys.

There’s no special medication for roseola, and in most cases, it will go away on its own without treatment.

However, here are several ways to treat the symptoms:

  • Anti-inflammatory medication. Anti-inflammatory medications like acetaminophen or ibuprofen are approved for use in infants and children at lower doses than in adults. They can be purchased over the counter and can help lower fever and treat discomfort. Always consult your doctor before giving a child medication, and follow their instructions exactly.
  • Good hydration and adequate nutrition. This is also important in managing viral illnesses like roseola. Cool foods like popsicles may be soothing. Make sure you or your child drinks plenty of water. Dehydration can also be a side effect of a high fever and can contribute to seizures in children.
  • Dress your child in cool, breathable clothes. This can help prevent overheating.
  • Give your child a lukewarm bath. This can help them relax and regulate body temperature.

Aspirin should never be used in children under age 18 because its use in children has been linked to a rare but life threatening condition called Reye‘s syndrome. Children and teens recovering from chickenpox or the flu also shouldn’t take aspirin.

In certain children or adults with a weakened immune system, physicians might prescribe an antiviral drug, such as ganciclovir (Cytovene). However, these drugs are not officially approved to treat HHV-6, one of the viruses that cause roseola.

Why don’t antibiotics work for roseola?

Antibiotics are not effective against roseola because it is caused by a virus. Antibiotics are only effective in treating bacterial infections.

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A child with roseola can return to normal activities when they are feverless for at least 24 hours without the use of fever medications, and when other symptoms have gone away. Roseola is contagious in the fever phase, but it’s usually not contagious when only a rash is present.

If someone in the household has roseola, it’s important to wash hands frequently to prevent spreading the illness to others. Wearing a medical-grade face mask may also lessen the chance of transmission.

You can help your child recover by making sure they get enough rest and stay hydrated. Most kids will recover within a week of the first signs of fever.

Some people confuse the roseola skin rash with the measles skin rash. However, these rashes both have distinct characteristics:

  • The measles rash is red or reddish-brown. It usually starts on the face and works its way down, ultimately covering the entire body with blotches of bumps.
  • The roseola rash is pink or “rosy” in color and typically starts on the abdomen before spreading to the face, arms, and legs.

Children with roseola typically feel better once the rash appears. However, a child with measles may still feel ill while they have a rash.

Measles has a vaccine, while roseola does not. The measles vaccine is usually given in 2 doses in infancy and early childhood. Per the CDC, having both doses is 97 percent effective at preventing measles.

Around 90 percent of roseola infections occur in children under the age of 2.

Call your child’s doctor if they:

  • have a fever higher than 103°F (39.4°C)
  • have a fever that lasts longer than 5 days
  • have a rash that hasn’t improved after 3 days
  • stop drinking fluids
  • experience a decrease in urination
  • seem unusually sleepy or irritable

You should contact emergency services or your doctor if your child experiences a febrile seizure or if seizures recur. In general, if roseola symptoms worsen or don’t improve within a week, it’s best to get professional medical help.

Roseola can sometimes be difficult to diagnose because its symptoms mimic those of other common illnesses in kids. Also, because the fever comes and then goes away before the rash appears, roseola is usually diagnosed only after the fever is gone and your child is feeling better.

Children with roseola have a good outlook, and the illness usually resolves on its own. Long-term complications of roseola are rare.

Most children develop antibodies to roseola by the time they are toddlers, which makes them immune to a repeat infection. Some adults who never had the infection in childhood, and those with compromised immune systems, may still be at risk of catching it.

In most cases, roseola causes a high fever for a few days followed by a signature rash. The illness is contagious in the fever phase but not the rash phase. Diagnosis is based on symptoms. Treatments focus on providing comfort and reducing fever.

There is no vaccine for roseola, but good hygiene and frequent handwashing can help prevent the spread. Talk with a doctor if you or your child is experiencing symptoms.