Roseola differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Differential diagnosis

• Roseola, also known as HHV-6 must be differentiated from all other childhood diseases that cause rash, and fever. The following table summarizes the differential diagnosis for roseola.

Condition	Clinical features
Roseola	Exanthem; Appears as the fever disappears, Starts on the neck and trunk and spreads to the extremities. Enanthem; Macules or ulcers at the uvulopalatoglossal junction aka Nagayama spots.
Rubella (German measles)	Exanthem; Appears at the same time as the low grade fever, Begins on face and spreads down the whole body within 24 hours. Enanthem; Pinpoint petechiae on the soft palate aka Forchheimmer spots.
Rubeola (Measles)	Prodrome; Cough, Coryza, Koplik spots. Exanthem; Begins on face and spreads down body. Erthematous lesions begins as small macules which enlarge and coalesce. Enanthem; 1-3mm whitish, grayish or bluish spotswith an erythematous base seen in the buccal mucosa aka koplik spots.
Enteroviral Infection (e.g Hand, foot and mouth disease)	Epidemiology; Occurs in epidemics in spring, summer and fall. Exanthem; Macular, maculopapular or vesicular, Typically involves hands, feet, legs, buttocks and mouth. Enanthem; Oral ulcers.
Erythema infectiosum	Prodrome; Minimal/non-specific symptoms( fever, headache, nausea, diarrhea). Exanthem; Starts as prominent rashes on the cheeks, Blanching erythema on the trunk and feet may occur.
Scarlet fever	Exanthem; Diffuse erythematous sand paper like rash preceeded by pharyngiitis, Followed by a confluent petechiae, desquamationn and even frank peeling of the skin occurs following resolution of the eruption. Enanthem; Strawberry tongue
Drug allergy	Exanthem; Often begins in dependent areas before generalising Includes macules, papues, vesicles and petechiae