High Fever with Small Pink Rashes – Complications of Roseola in Toddlers

High Fever with Small Pink Rashes – Complications of Roseola in Toddlers

A rash is an outbreak of red spots or patches on the body which can be a sign of an underlying disorder. Rashes can occur due to allergic reaction from various substances or from infections. But if the rashes are accompanied by high fever, it can be a discomforting experience, especially for a child.


Roseola is referred to a contagious skin disorder that occurs due to a viral infection. It exhibits in the form of fever, accompanied by signature skin rash. Roseola is also known as with other terms such as ‘sixth disease’, roseola infantum, exanthem subitem or ‘false measles’.

The infection is typically not a serious one and usually affects babies and toddlers upto the age of 3 years. The reason behind why this illness does not affect newborns is that neonates are protected by antibodies present in the breast milk. But with the time, this immunity starts to decline.

How common is roseola?

Roseola is a very common skin condition and most kids will have it by the time they enter kindergarten. It rarely affects adults unless they had never contracted the virus in the childhood.

Signs and symptoms of roseola

The most classic symptom of roseola is sudden high fever followed by skin rashes. Typically, a fever is considered as higher if the temperature of the child is 102-105 degree Fahrenheit (38.8-40.5°C). Some kids develop only a mild form of the illness while some other never show any signs of illness.

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How long fever in roseola lasts?

Children who develop full range of sign and symptoms will typically experience high fever. The fever usually lasts between 3 and 7 days. After the fever goes away, rashes pop up within 12-24 hours.

Size and color of rashes

The rashes on the skin are typically 3mm-5mm in size and pink in color. They are often raised or flat in appearance. The rashes begin on the abdomen before spreading to the face, arms and legs. This denotes that the virus is at its last stage of course.

Some children may experience other symptoms including:

  • Ear pain
  • Swelling in eyelids
  • Irritability in infants and toddlers
  • Swollen glands
  • Decreased appetite
  • Mild diarrhea
  • Runny nose
  • Mild cough or sore throat
  • Febrile seizures, which are convulsions due to a high fever

What causes roseola?

The most common cause of roseola is the exposure to human herpes (HHV) virus type 6. However, the disease can also occur due to type 7 virus. Like any other contagious disease, roseola spreads from person to person contact via coughing, sneezing or respiratory secretions.

Incubation period

The outbreak of roseola can occur at any time of the year. Once the child catches the virus, it takes between 5 and 15 days before signs and symptoms appear. During this period, the infected person can spread the disease to another one.

Roseola vs Measles – What’s the difference?

Sometimes many people get confused between the roseola skin rash and measles skin rash. Both these are different from each other. Here are some of the main differences between the two:

  1. Roseola rashes are pink or rosy while measles rashes are red or reddish-brown in color.
  2. Roseola rashes start first on the abdomen and then spread to other parts such as face, arms and legs. Measles rashes start on the face and then move down to other body parts.
  3. Kids with roseola will typically start feeling better once the rashes appear, while kids with measles might feel ill while they still have rashes.

Complications of roseola – When to call the doctor

Roseola rarely causes complications in children. However, when complications occur, it can cause seizures in children. If this happens, the child can briefly lose consciousness and feel jerkiness in heads, arms and legs.

Call the doctor if your child experience following symptoms:

  • Rapid rise in body temperature, higher than 103 degree Fahrenheit (39.4°C)
  • Loss of bowel control temporarily
  • Rashes that haven’t improved after 3 days
  • Symptoms that doesn’t improve but only worsen
  • Fever that last longer than 7 days
  • Decrease in fluid intake

Roseola is a greater concern for people with compromised immune system such as individuals with HIV or those who have recently gone through bone or organ transplant. Since these people have lost resistance to virus, they tend to develop more serious cases and need longer time to fight infection. These people may develop:

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Diagnosis of roseola

The condition can be sometimes difficult to diagnose as the signs and symptoms resembles to those of other common disorders in children. Moreover, since the fever comes and then heals on its own before appearance of the rashes, the diagnosis is typically done after the fever is gone and the child starts feeling better.

Physical examination

The doctor can confirm the diagnosis by mere spotting the rashes and the symptoms.

Blood test

The doctor may also order a blood test to examine the antibodies that erupts against roseola. However, this is rarely required.

Does roseola need any treatment?

In one word, no. By the time the doctor or pediatrician will come to know, the child would have already recovered. Most children will recover within a week after the onset of the fever. Also, there is no specific treatment of this disease.

The doctors do not prescribe any kind of antibiotic medicine as they are used to treat infection caused by bacteria. However, the doctor may suggest:

  • Over-the-counter pain relievers such as ibuprofen or acetaminophen. This would also work for fever as well.
  • Antiviral drugs such as ganciclovir to people with weakened immune system
  • Extra intake of fluids as roseola may cause dehydration

Recovery and outlook

After the fever resolves in 24 hours and subsiding of other symptoms, the child can return to normal activity. Remember, roseola is not contagious when rash appears, but spreadable in the fever phase. Make sure your child stay hydrated and take plenty of rest.

The outlook for roseola is pretty good as by the time kids reach the age of schooling, they develop antibodies which make them immune against the disease in future.


1. Human Herpes Virus 6 and Roseola (n.d.). The University of Chicago read more
2. Roseola in Children (n.d.). Johns Hopkins Medicine Health Library read more
3. Roseola Infantum (2015, November 21). Healthy Children read more
4. Roseola Infantum/Sixth Disease (2015, May 25). Cleveland Clinic read more