Roseola

Signs and Symptoms

• Sudden high fever (103 to 106°F [39.4 to 41.1°C]), which usually lasts 3 to 5 days. Your child will probably remain alert in spite of the fever.
• High fever can cause febrile seizures. Although these seizures usually are not harmful and go away when the fever goes down, you should take your child to the emergency room if they have a seizure.
• A rash appears as the fever goes away and lasts 3 to 4 days. It may look like measles or rubella, with small rose-colored bumps. Some of the bumps may have a white ring around them. The rash usually appears first on the trunk of the body. It may spread to the neck, arms, and legs, but rarely on the face.
• Fatigue, irritability, decreased appetite, runny nose, and swollen eyelids.
• Breathing problems, ear infections, and diarrhea can also occur.

What Causes It?

Roseola is caused by 2 kinds of herpes viruses. The most common one is herpes virus 6 (HHV-6). Herpes virus 7 can also cause roseola. These are not the same herpes viruses that cause cold sores or genital herpes.

Roseola is spread through saliva and respiratory secretions, so coughing and sneezing can spread the virus. The incubation period is 5 to 15 days. It is contagious, whether or not the child has a rash.

What to Expect at Your Doctor's Office

Your child's doctor will look for the rash and may take blood to check for other conditions and complications. Your child's doctor will also take your child's temperature and talk to you about how to treat your child's roseola at home.

Treatment Options

There is no cure for roseola. Most treatments reduce fever, letting the infection run its course. Make sure your child drinks a lot of fluids to prevent dehydration. Water and other clear fluids are fine. You may want to use drinks that contain electrolytes, such as Pedialyte. Most children get better within a week.

Drug Therapies

• Your doctor may suggest giving children's acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to bring down the fever. DO NOT give your child aspirin. Children under 18 should never take aspirin because of the risk of Reye syndrome, a potentially fatal condition.
• Phenobarbital is sometimes given for seizures.
• For people with weakened immune systems, a doctor may prescribe the antiviral medication ganciclovir (Cytovene).

Complementary and Alternative Therapies

Herbal teas may help reduce fever. Always ask your pediatrician before giving any herb or supplement to a child. Vitamins and herbs can interact with other medications. This is why it is crucial to talk to your pediatrician first.

To determine a child's dose for herb teas, ask your pediatrician. For some herb teas, the mother may drink them to treat breastfeeding babies. Always check with your pediatrician before using herbs while breastfeeding.

Your child should get plenty of rest and fluids.

These nutrients are often used to help strengthen the immune system and fight infection. The right dose varies depending on the age and weight of the child. Ask your pediatrician to help you find the right dose, and do not give any of these vitamins or supplements to a child without your pediatrician's approval.

• Vitamin C may help fight a viral infection.
• Zinc may increase immune system activity.
• Selenium may help children recover more quickly from viral infections.
• Vitamin E helps support the immune system.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts).

To determine the right dose for a child, ask your pediatrician. Always ask your doctor before giving herbs to a child. Some herbs can interact with other medications or cause allergies and might not be safe for your child to take.

These herbs are often used to reduce fever:

• Lemon balm (Melissa officinalis)
• Peppermint (Mentha piperita)
• Elder (Sambucus nigra)
• Chamomile (Matricaria recutita) -- People with allergies to ragweed may be sensitive to chamomile

Use equal parts of the above herbs to brew a tea. If you are breastfeeding, you can drink 1 cup, 3 to 4 times per day to pass the benefits along to your baby (under your doctor's guidance).

Garlic and ginger tea. With 1 to 3 cloves of garlic (Allium sativum) and 1 to 3 slices of fresh ginger (Zingiber officinale) may help stimulate the immune system and prevent upper respiratory infections. You can add lemon and a sweetener for flavor. DO NOT give honey to children under 2 years old.

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for roseola based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum. For children who have a sudden high fever, especially when the fever is accompanied by restless anxiety. This remedy is best when used very early in disease, before a rash appears.
• Belladonna. For children who have a sudden high fever that rises during the night and is accompanied by flushed face and red lips. The skin tends to be hot to the touch, but extremities feel cold. Children for whom this remedy is appropriate tend to be very agitated and may even be delirious.
• Arsenicum album. For children whose fever increases between midnight and 2 am, and who are fidgety and have pain in their legs.
• Pulsatilla. For children who have fever and chills that are worse in warm rooms, but better in fresh air. Symptoms tend to be less intense than for the other remedies listed.

Acupressure for children may be calming and help reduce the fever.

Gentle massage may help your child feel better. A foot massage may help. However, some children will not want to be touched.

Following Up

Most children get well within about a week with no problems. If your child has a seizure, call your doctor or go to the emergency room immediately.

Special Considerations

Avoiding infected children is the only way to prevent roseola. There is no vaccine.

Supporting Research

Afenjar A, Rodriguez D, Rozenberg F, et al. Human herpes virus type 6, etiology of an acute encephalitis in childhood: Case report. Arch Pediatr. 2007;14(5):472-475. PMID: 17306516 www.ncbi.nlm.nih.gov/pubmed/17306516.

Beck, MA. Nutritionally induced oxidative stress: effect on viral disease. Am J Clin Nutr. 2000;71:1676S-681S. PMID: 10837315 www.ncbi.nlm.nih.gov/pubmed/10837315.

Ferri FF. Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Gamkrelidze N, Butsashvili M, Barabadze K, Kamkamidze G. Rare recurrence of seizures in children with episodes of febrile seizures associated with herpes virus 6 infection. Georgian Med News. 2006;(134):88-90. PMID: 16783075 www.ncbi.nlm.nih.gov/pubmed/16783075.

Yildirim M, Aridogan BC, Baysal V, Inaloz HS. The role of human herpes virus 6 and 7 in the pathogenesis of pityriasis rosea. Int J Clin Pract. 2004;58(2):119-121. PMID: 15055857 www.ncbi.nlm.nih.gov/pubmed/15055857.