Roseola differential diagnosis

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

Overview

Roseola must be differentiated from other diseases that cause fever and rash, such as Rubella (german measles), Rubeola (measles), hand foot and mouth disease caused by coxakie virus, erythema infectiosum caused by parvovirus B19, scarlet fever and even drug allergy.

Differential diagnosis

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

Disease	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 also known as 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 alsp known as 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 spots with an erythematous base seen in the buccal mucosa known as 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 rash 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 generalizing Includes macules, papues, vesicles and petechiae