Iowa Health Book: Pediatrics

Erythema Infectiosum (Fifth Disease)

Fifth Disease, Slapped Cheek Disease, Academy Rash

General information

Erythema infectiosum is a common disease of school children characterized by a red rash on the cheeks followed by a lacy rash on the arms and legs. It usually causes very little illness although adolescents sometimes have mild joint pains or swelling. Erythema infectiosum was given the name "fifth disease" because it was the fifth of the childhood rashes (measles, German measles, etc.) to be described.

The disease is caused by parvovirus B19. It is spread by direct contact with infected mucus from the nose or mouth or by inhaling droplets coughed or sneezed into the air. Illness starts from 4 to 18 days after exposure. Because of the close and prolonged contact between students, epidemics of fifth disease are common in primary schools and academies.

The illness

Fifth disease rash sometimes begins with no illness at all but usually starts with 3 or 4 days of low grade fever and symptoms of a mild cold. This is followed in several days by the appearance of a bright red, raised rash which covers the cheeks, making them look as if they had been slapped. The area around the mouth is usually not involved. After another 1 to 3 days a pink, blotchy and often itchy rash appears on the upper part of the arms and legs, spreading to the trunk and buttocks. As it fades, the rash develops a lace-like or "net-like" appearance which can last for 5 to 10 days. Once cleared, it may reappear for several weeks or months if the skin becomes flushed from exercise, sunlight or a warm bath.

Young adults with parvovirus infection can have mild joint pains and swelling (arthritis), often without a rash. The hands, knees and wrists are most commonly affected. Discomfort lasts from a few days to several months. There is no permanent joint damage.

There are no complications from infection in a normal child. Children with blood problems such as sickle cell disease and those with certain cancers or on chemotherapy can develop severe anemia (low red blood cells), usually without a rash. Infection in pregnant women can cause anemia in the unborn baby.

When to call your doctor

You should call our office if you feel frightened or worried about your child's illness. Call us during regular office hours (or on weekends) if your child develops: fever over 102 degrees F (39 degrees C), severe joint pains.

Treatment

Most children with erythema infectiosum do not need medication. Acetaminophen (e.g. Tylenol, Tempra, Panadol, Liquiprin) or ibuprofen (e.g. Motrin, Advil, PediaProfen) can be given for joint pain and swelling. Antihistamines, such as Benadryl, taken by mouth are helpful in reducing itching. There is no need to change your child's diet or to restrict activities.

Contagion

Children with erythema infectiosum can be contagious any time from 2 weeks to 3 days before appearance of the rash (or joint pains). They usually feel perfectly well or have only a mild illness at this time and continue to play with other children. Thus, little can be done to stop the spread of this infection.

Return to group activities

Children are no longer contagious and do not need to be excluded from school or day care once the rash has been determined to be fifth disease.

Common concerns

The rash on the cheeks can be very impressive but is not painful. Children in whom the rash recurs are not contagious. Pregnant women in contact with your child between 2 weeks and 3 days before the rash should speak with their doctor. Blood tests to check for immunity or infection are available. Fortunately most adults have had parvovirus infection during childhood and are no longer at risk of catching the illness.

Taken from: Pediatric Infectious Diseases Journal

Editor, S. Michael Marcy, M.D.; Associate Editors, Michael E. Pichichero, M.D., and Richard H. Schwartz, M.D.

Author: Noni E. MacDonald, M.D., F.R.C.P.C.; Professor of Pediatrics and Head, Division of Infectious Disease Service, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

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