The second phase of roseola begins after a few days of fever. As the fever subsides, a rash begins to appear, first on the neck and upper part of the body, then spreading down to the trunk and out to the arms and legs. Typically, the face is spared. At this point, the diagnosis is a lot easier to make based on the appearance of the red, bumpy spots that appear, and the child feels well. This rash fades over two days or so, and sometimes after only a few hours, without any specific treatment. Recovery is then complete and the virus slides into its latent phase. Aside from the risk of a febrile seizure, complications are rare.
Since there is no specific treatment available for roseola, the best interventions are those that keep the child comfortable and cool. Fluids are important to prevent dehydration, and acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can help with fever control. A doctor’s efforts will be directed toward making sure other serious infections aren’t the cause of the fever, at least until the characteristic rash appears. Until we have accurate tests for roseola and an effective medicine, this illness will continue to infect virtually all of us. This is a case of hoping that medical science will soon catch up to a wily and common foe.