eMedicine Specialties > Dermatology > Viral Infections

Human Herpesvirus 6: Treatment & Medication

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers; Ewa Koziorynska, MD, Staff Physician, Department of Neurosciences, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Jun 18, 2009

Treatment

Medical Care

In roseola, symptomatic treatment of the fever is recommended, including baths, lightweight clothing, and rest. Fluids are encouraged. If the patient has a febrile seizure, no seizure medication is necessary.

  • To evaluate the influence of ganciclovir (GCV) prophylaxis on human herpesvirus 6 (HHV-6) replication in renal transplant recipients, Galarraga et al21 studied 3 groups, (1) patients not taking GCV, (2) patients taking short-term GCV prophylaxis (<30 d), and (3) patients taking long-term GCV prophylaxis (>60 d). The antiviral did not affect the prevalence of HHV-6 (67.2%), but HHV-6 viremia appeared after (42 ±31 d posttransplant) and was shorter (29 ±30 d) among patients on long-term GCV prophylaxis.
  • Because HHV-6 and HHV-7 are possibly associated with pityriasis rosea, systemic drugs directed against HHV may hasten recovery of patients with pityriasis rosea. High-dose acyclovir may be effective in the treatment of pityriasis rosea, especially in patients treated in the first week from onset, when replicative viral activity of HHV is probably very high.22

Consultations

Consult a pediatrician for evaluation of any atypical findings.

Activity

Advise rest for children with roseola until the fever breaks and the rash appears.

Medication

Although human herpesvirus 6 (HHV-6) is inhibited by several antiviral drugs in the laboratory (eg, GCV, foscarnet), no clinical trials have assessed their benefit. No seizure medication is indicated for febrile seizures. Antipyretics (eg, acetaminophen) can be given for high fever. Avoid aspirin in children because of the risk of Reye syndrome.

The effectiveness of ganciclovir was evaluated against HHV-6 excreted in saliva in stem cell transplant recipients.23 Ganciclovir can decrease the HHV-6 viral load in saliva.

Antipyretics

These agents are indicated for an excessively high fever.


Acetaminophen (Tylenol, FeverAll, Anacin-Free Aspirin)

Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Adult

325-650 mg PO q4-6h prn

Pediatric

10-15 mg/kg PO q4-6h prn

Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Documented hypersensitivity; known G-6-PD deficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible in persons with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in cumulative doses exceeding recommended maximum dose

More on Human Herpesvirus 6

Overview: Human Herpesvirus 6
Differential Diagnoses & Workup: Human Herpesvirus 6
Treatment & Medication: Human Herpesvirus 6
Follow-up: Human Herpesvirus 6
References
Further Reading
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References

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  15. Watanabe T, Nakashima H, Ohmatsu H, Sakurai N, Takekoshi T, Tamaki K. Detection of human herpesvirus-6 transcripts in carbamazepine-induced hypersensitivity syndrome by in situ hybridization. J Dermatol Sci. May 2009;54(2):134-6. [Medline].

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  21. Galarraga MC, Gomez E, de Ona M, et al. Influence of ganciclovir prophylaxis on citomegalovirus, human herpesvirus 6, and human herpesvirus 7 viremia in renal transplant recipients. Transplant Proc. Jun 2005;37(5):2124-6. [Medline].

  22. Drago F, Vecchio F, Rebora A. Use of high-dose acyclovir in pityriasis rosea. J Am Acad Dermatol. Jan 2006;54(1):82-5. [Medline].

  23. Ljungman P, Dahl H, Xu YH, Larsson K, Brytting M, Linde A. Effectiveness of ganciclovir against human herpesvirus-6 excreted in saliva in stem cell transplant recipients. Bone Marrow Transplant. Apr 2007;39(8):497-9. [Medline].

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Keywords

HHV-6, human herpes virus 6, roseola, human herpes virus 6A, HHV-6A, human herpes virus 6B, HHV-6B, exanthem subitum, roseola infantum, mononucleosis syndromes, focal encephalitis, pneumonitis, common childhood illness

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers
Disclosure: Nothing to disclose.

Ewa Koziorynska, MD, Staff Physician, Department of Neurosciences, UMDNJ-New Jersey Medical School
Ewa Koziorynska, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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