Fifth disease also known as Erythema infectiosum and slapped cheek is common in children especially during late winter or early spring. Fifth disease is usually not a serious condition and often requires no treatment.

What Causes Fifth Disease?

5th disease is a viral infection caused by human Parvovirus B19. The disease is spread by exposure to airborne droplets from the nose and throat of infected person. Once the person is infected he receives lifelong immunity so it won’t recur again.

Symptoms of Fifth disease

One or two weeks after your child has been exposed to the virus, some children will experience non-specific symptoms such as low grade fever, headache and tiredness. Approximately 2 days after the symptoms red rash appears on the cheeks which may look like slapped face. The rash may suddenly develop without any symptoms. Areas like nasal, perioral and periorbital are spared. This rash usually fades over 2-4 days.

After the facial rash fades over 2-4 days, pink, red rash start to appear on the trunk, neck and extensor surface of hands and legs. Sometimes, palms and soles may also be involved. These rashes have central fading giving lacy appearance. These rashes tend to fade and reappear in time. Rash may reappear due to exposure to sunlight, heat or temperature change, fever, exercise, bathing and emotional stress. Sometimes the rash may be itchy. In this stage children may have sign of illness or asymptomatic. It is estimated that around 10% of children with fifth disease will develop joint pain. Large joints are usually affected.

How is fifth disease diagnosed?

Your doctor will diagnose the fifth disease based on the clinical presentation alone; other investigations are usually not required.

Fifth Disease Treatment

There is no specific treatment for fifth disease. As fifth disease in self-limiting harmless condition, no treatment is generally required. Treatment approach is based on preventing the complications and symptomatic relief. Supportive therapy for pain and itching can be gained by using oral analgesics and antihistamines or topical anti-itch lotions.

Are there any complications in children?
Generally there are no complications in normal healthy children.

Avoid your child from excessive sunlight exposure, heat and other external factors that might cause rash fare-ups.

Vaccine for fifth disease
Currently, there is no effective vaccine to prevent fifth disease. Clinical trial of a parvovirus B19 vaccine was terminated due to unexplained cutaneous events [1].


1.Bernstein DI, El Sahly HM, Keitel WA, Wolff M, Simone G, Segawa C, Wong S, Shelly D, Young NS, Dempsey W. Vaccine. 2011 Oct 6;29(43):7357-63. Epub 2011 Jul 30