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Clinical Summary

The typical presentation of roseola infantum involves a prodrome characterized by a 3- to 5-day history of high fever often exceeding 40°C (104°F) in a child 6 months to 3 years of age. The child may be fussy and have lymphadenopathy and Nagayama spots (erythematous papules on the soft palate and uvula), but is often otherwise well appearing. After the child’s fever abruptly abates, the typical exanthem appears, characterized by blanching erythematous macules and papules on the trunk, neck, proximal extremities, and occasionally the face. The evanescent rash fades within 2 to 4 days but may only last several hours. The causative agent in 90% of cases is human herpesvirus 6 (HHV-6). The differential diagnosis includes viruses such as measles, rubella, parvovirus B19, or infectious mononucleosis. Bacterial infections (eg, scarlet fever), drug reactions, guttate psoriasis, papular urticaria, and erythema multiforme are also included in the differential.

FIGURE 14.21

Roseola Infantum (Exanthem Subitum). Toddler with maculopapular eruption of roseola. (Photo contributor: Raymond C. Baker, MD.)

Management and Disposition

As with most viral infections, only supportive therapy is necessary. Special attention should be paid to maintaining fluid intake, controlling fever for the patient’s comfort, and educating parents about the benign, self-limited nature of this illness.


  1. With defervescence and appearance of the rash, the patient is no longer contagious.

  2. The most frequent complication of roseola is febrile seizures.

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