• Bright red or rosy rash on both cheeks for 1 to 3 days ("slapped cheek" appearance)
• Rash on cheeks is followed by pink "lacelike" (or "netlike") rash on extremities
• "Lacy" rash mainly on thighs and upper arms; comes and goes several times over 1 to 3 weeks
• No fever or low-grade fever (less than 101°F [38.4°C])

Similar Conditions:

Fifth disease was so named because it was the fifth pink-red infectious rash to be described by physicians. The other four are:

1. Scarlet fever
2. Measles
3. Rubella
4. Roseola (controversial)

Cause:

Fifth disease is caused by the human parvovirus B19.

Expected Course:

This is a very mild disease with either no symptoms or a slight runny nose and sore throat. The lacelike rash may come and go for 5 weeks, especially after warm baths, exercise, and sun exposure.

HOME CARE

Treatment - No treatment is necessary. This distinctive rash is harmless and causes no symptoms that need treatment.

Contagiousness - Over 50% of exposed children will come down with the rash in 10 to 14 days. The disease is mainly contagious during the week before the rash begins. Therefore exposed children should try to avoid contact with pregnant women, but that can be difficult. Once the child has "slapped cheeks" or the lacy rash, he is no longer considered contagious and does not need to stay home from school.

Adults with Fifth Disease - Most adults who get fifth disease develop just a mild pinkness of the cheeks or no rash at all. Adults develop joint pains, especially in the knees, more often than a rash. These pains may last 1 to 3 months. Taking a nonprescription ibuprofen product usually relieves these symptoms. An arthritis workup is not necessary for joint pains that occur after exposure to fifth disease.

Refer Pregnant Women Exposed to Fifth Disease to Their Obstetrician - The risk of fifth disease is to the unborn babies of pregnant women. If a pregnant woman is exposed to a child with fifth disease, she should see her obstetrician. The doctor will obtain an antibody test to see if the mother already had the disease and is therefore protected. If not, the pregnancy will need to be monitored closely. Some fetuses infected with fifth disease before birth develop complications. Ten percent develop severe anemia and 2% may die. Birth defects, however, are never a result of this virus.

CALL OUR OFFICE

DURING REGULAR HOURS if:

• The rash becomes itchy.
• Your child develops a fever over 102°F (38.9°C).
• You have other concerns or questions.
  

Adapted from Instructions for Pediatric Patients by Barton Schmitt (2nd edition, 1999) with permission from the author.

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