Doctors’ Notes

Fifth Disease

There are moments in life that, sooner or later, are guaranteed to occur despite our best efforts. Tax season will come every April. Pittsburgh will have more rainy days than sunny days. And you’ll eventually get a phone call about your child and the feared, dreaded, horrifying, relentless illness known as… “The Rash”!

Now, don’t panic!

The good news is that rashes in children are typically mild and will get better on their own. The bigger questions tend to be, “How long is my child contagious?” and “When can they go back to daycare?” While some rashes can be difficult to identify, there is a common, well-known rash that you are sure to see or hear about as your child grows up. This rash is called “Fifth Disease.” You may know it better as the “Slapped Cheeks Rash” (so-named because children often get a bright red rash on the cheeks), or “Erythema Infectiosum” (the more scientific/smart-sounding name. This makes it sound scary and maybe even deadly, so we’ll avoid this one.)

Who or What is Responsible?

This particular infection is a virus caused by Parvovirus B19. (The B19 refers to the particular sample of blood when it was first discovered). Hard to believe this little guy is the cause of all this trouble:

This virus, which is spread by nasal secretions/close contact, is common among daycare/school-aged children. By adulthood, over 50% of people have already been exposed or had the infection.

This Doesn’t Sound Like Fun. What Symptoms Can I Expect to See?

Fifth Disease often starts out as mild flu-like symptoms (headache, sore throat, fever, tired). The rash typically starts on the face (and, again, looking like slapped cheeks):

Though it can sometimes be itchy, the rash usually doesn’t cause any pain or discomfort. Sometimes children have no symptoms before the rash.

Older children often have swelling/pain in their joints. Later the rash spreads to the trunk and extremities (usually with a lacy appearance):

Are Tests Needed to Confirm the Diagnosis?

The diagnosis of Fifth Disease is a clinical diagnosis (meaning we determine it based on the history you provide and the physical exam in the office). In cases when the diagnosis is not clear or needs to be confirmed, blood tests are available.

How Long Will My Child Have it?

The cold symptoms before the rash usually last for only a few days. The rash typically resolves after one week but can sometimes last 2-3 weeks.

Ok. We’ve Established My Child Has It. Now What?

Like many viruses, Fifth Disease is a self-limiting illness (which means it will resolve on its own). You can provide Tylenol/Motrin early on for the flu-like symptoms, or for patients who have joint pain. You can also provide Benadryl if the rash is itchy.

Will Antibiotics Help?

Because Fifth Disease is a viral illness, antibiotics will NOT help with the infection.

Is My Child Contagious? When Can He/She Go Back to School?

Patients are contagious during the initial flu-like symptoms. By the time the rash is present, your child is no longer contagious, and can return to school/day care (though many places may require a note from your provider).

Are There Any Complications?

Most children recover from Fifth Disease without any problems. Those who may run into complications include patients with red blood cell disease (such as sickle cell disease) and patients with a suppressed immune system (including patients on immune suppressive medications).

Anything Else I Should Know?

Patients with suspected/confirmed Fifth Disease should NOT be in contact with anyone who is or may be pregnant — especially during the first five months of pregnancy. If there’s concern for exposure, call your primary care provider.

So there you have it, another rash demystified! As always, if you have any questions or concerns, please don’t hesitate to ask. That’s why we’re here!

Dr. Chris Deskins is a former Kids Plus provider.