Roseola infantum

Last updated: January 5, 2022

Summarytoggle arrow icon

Roseola infantum (exanthem subitum, three-day fever) is a viral exanthematous infection caused by the human herpes virus 6 (HHV-6; in rare cases, HHV-7) that mainly affects infants and toddlers. Infection is characterized by high fever, which ends abruptly after three to five days, followed by the sudden appearance of a maculopapular rash. The rash generally appears mainly on the trunk, but sometimes spreads to the face and extremities, and fades within two days. Roseola infantum is a self-limiting condition that is only treated symptomatically. Febrile seizures are a possible complication of infection; however, most patients recover from these seizures without any adverse outcome.

Epidemiologytoggle arrow icon

  • Most frequent in infants and young children
  • Peak incidence: 6 months to 2 years


Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon


Clinical featurestoggle arrow icon

Febrile phase

Exanthem phase

  • Duration: 1–3 days
  • Characteristic presentation: subsequent sudden decrease in temperature and development of a patchy, maculopapular exanthem
    • Rose-pink in color; blanches upon pressure
    • Nonpruritic (in contrast to the drug allergy rash)
    • Originates on the trunk; ; sometimes spreads to the face and extremities

The names of the disease reflect its two phases: Three-day fever refers to 3 days of high fever; exanthem subitum (from Latin: "subitus" = sudden) describes a "sudden exanthem" (upon fever cessation).


Diagnosticstoggle arrow icon


Differential diagnosestoggle arrow icon


The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon


Complicationstoggle arrow icon


We list the most important complications. The selection is not exhaustive.

Prognosistoggle arrow icon

  • Very good prognosis; self-limiting disease
  • The virus persists lifelong in its host, and reactivation of latent virus or reinfection may occur later in life (especially if individuals become immunocompromised)


Referencestoggle arrow icon

  1. Marcdante K, Kliegman RM. Nelson Essentials of Pediatrics E-Book. Elsevier Health Sciences ; 2018
  2. Tesini BL, Epstein LG, Caserta MT. Clinical impact of primary infection with roseoloviruses. Curr Opin Virol. 2014; 9: p.91-96.doi: 10.1016/j.coviro.2014.09.013 . | Open in Read by QxMD
  3. Tremblay C. Virology, Pathogenesis, and Epidemiology of Human Herpesvirus 6 Infection. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: November 14, 2016. Accessed: March 19, 2018.
  4. Goljan EF. Rapid Review Pathology. Elsevier Saunders ; 2013
  5. Gorman CR. Roseola Infantum. In: James WD, Roseola Infantum. New York, NY: WebMD. Updated: June 2, 2016. Accessed: March 19, 2017.
  6. McKinnon HD, Howard T. Evaluating the febrile patient with a rash. Am Fam Physician. 2000; 62 (4): p.804-816.
  7. Tremblay C, Brady MT. Roseola Infantum (Exanthem Subitum). In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: October 12, 2015. Accessed: March 19, 2017.
  8. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier Health Sciences ; 2014

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer