Fifth Disease

Fifth disease is a temporary bright red skin rash that appears after a parvovirus B19 infection. It mainly affects children but can affect adults, as well. Fifth disease usually goes away on its own after several days.


Illustration of a child with a lacey red rash on their cheek.
Fifth disease is a childhood condition that appears as a bright red rash on your child’s cheeks.

What is fifth disease?

Fifth disease (erythema infectiosum) is a childhood condition that appears as a bright red rash on your child’s cheeks. It’s nicknamed “slapped cheek disease” because of this rash. A virus called parvovirus B19 causes fifth disease. This virus is common and very contagious. Infected people can spread it through coughing or sneezing.

In most cases, fifth disease isn’t a serious medical condition. It often goes away with minimal or no treatment.

Why is it called fifth disease?

Fifth disease got its name because it was the fifth viral skin rash known to affect children in a list of six conditions. The list is as follows:

  1. Measles.
  2. Scarlet fever.
  3. Rubella (German measles).
  4. Dukes’ disease.
  5. Erythema infectiosum (fifth disease).
  6. Roseola.

How common is fifth disease?

Fifth disease is one of the six most common viral rashes in children. It typically affects children between 5 and 15 years old, especially in the spring and summer months.

Can adults get fifth disease?

Fifth disease can affect adults, but this is rare. Once you’re exposed to the virus, your body’s immune system builds up defenses to fight it off. This means that if you had fifth disease as a child, you’ll likely be immune to it as an adult. Most adults have had fifth disease as a child.


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Symptoms and Causes

What are the symptoms of fifth disease?

A parvovirus B19 infection often starts with flu-like symptoms, which are usually mild. During this time, the virus is most contagious. These symptoms include:

About 20% of children who have a parvovirus B19 infection don’t have these symptoms. Still, they can pass the virus to others.

It can take several days after the onset of flu-like symptoms for the raised, bright red rash (fifth disease) to show up on your child’s face. The rash may be itchy. Children typically no longer have flu-like symptoms once the rash appears.

In some cases, you may see a second rash that develops after the cheek rash. It usually looks “lacey” and may appear on your child’s:

  • Arms.
  • Legs.
  • Trunk (chest and back).
  • Buttocks.

About 10% of children with fifth disease also experience joint pain and swelling.

Fifth disease symptoms in adults

Adults who are infected with parvovirus B19 often develop flu-like symptoms without the rash. Along with those symptoms, about 80% of adults also develop joint pain in their wrists, hands and knees.

What causes fifth disease?

Human parvovirus, also called parvovirus B19, causes fifth disease. This is different from the parvovirus that affects dogs and cats. Fifth disease (a red rash) typically appears four to 14 days after your child is infected with parvovirus B19.

Is fifth disease contagious?

Parvovirus B19 is very contagious. It mainly spreads through respiratory droplets in your mouth and nose. If an infected person talks, coughs or sneezes near your child, your child could become infected with the virus.

Parvovirus B19 can also spread through blood exposure from a pregnant person to a fetus, but this is rare.

However, fifth disease — the red rash caused by parvovirus B19 — isn’t contagious. In fact, once a person infected with parvovirus B19 gets the red rash, they’re no longer contagious (they can’t spread parvovirus B19 to other people).


What are the complications of fifth disease?

In healthy children and adults, fifth disease very rarely causes complications.

But the condition can cause problems for people who have a blood disorder or weakened immune system. This is because the virus can affect the way your body makes red blood cells. It can cause your child’s red blood cell count to drop so low that they need a blood transfusion.

Children (and adults) with the following conditions are at increased risk of complications:

If your child has any of these conditions, contact their healthcare provider as soon as the fifth disease rash appears or if they’re having flu-like symptoms, which usually come before the rash.

Fifth disease complications in adults

About 10% of adults who get a parvovirus B19 infection develop chronic (long-term) parvovirus-associated arthritis in several joints, or polyarthritis. People assigned female at birth (AFAB) are more at risk for this complication than people assigned male at birth (AMAB).

Fifth disease and pregnancy

If you’re pregnant and develop fifth disease (parvovirus B19 infection), it can spread to the fetus and cause complications, including:

  • Miscarriage.
  • Stillbirth (intrauterine fetal demise).
  • Hydrops fetalis (when large amounts of fluid build up in a fetus’s tissues and organs).

These complications are rare, however. Most adults and pregnant people have already been infected with parvovirus B19, so they’re protected. The risk of fetal loss when you get a parvovirus B19 infection while pregnant is approximately 2%. Pregnant people in their second trimester are at the greatest risk of developing complications from parvovirus B19, but complications can happen at all points of pregnancy.

If you’re pregnant and have been exposed to someone with fifth disease, contact your healthcare provider.

Diagnosis and Tests

How is fifth disease diagnosed?

Healthcare providers typically diagnose fifth disease based on your child’s symptoms.

The “slapped cheek” rash is a strong sign of this condition. When it’s accompanied by flu-like symptoms, your child’s provider can usually diagnose fifth disease in the office without any other tests. In very rare cases, your child’s provider may order blood tests to confirm fifth disease.


Management and Treatment

What is the treatment for fifth disease?

Fifth disease symptoms typically go away in a few weeks with minimal or no treatment. Your child’s healthcare provider may recommend over-the-counter (OTC) pain relievers that can treat fever, headaches and joint pain. These medicines include:

Be sure to follow the dosing instructions carefully.

If your child has a weakened immune system and develops fifth disease, they may need treatment in a hospital.


Can I prevent fifth disease?

There isn’t a vaccine to prevent fifth disease. Because the virus spreads easily through nasal and mouth droplets, good hygiene is the best way to prevent the disease. You can reduce your family’s risk of infection by:

  • Washing your hands frequently and thoroughly.
  • Sneezing or coughing into the crook of your elbow.
  • Avoiding close contact with an infected person.

Outlook / Prognosis

How long does fifth disease last?

The fifth disease rash should fade within five to 10 days after it develops.

If your child develops a second rash, it should go away in seven to 10 days. But in some cases, the rash can come and go for several weeks.

When can my child go back to school?

While your child has flu-like symptoms, they’re contagious and should stay home. Once the fifth disease rash appears, your child isn’t contagious anymore, so they can return to school or daycare if they feel OK.

Living With

When should I see my healthcare provider?

Reach out to your healthcare provider if you think you or your child has fifth disease or has been exposed to the virus, especially if you or your child has:

  • Severe joint pain.
  • An itchy rash.
  • A pregnancy.
  • A weakened immune system.
  • A blood disorder.

What questions should I ask my doctor?

If your child has fifth disease, you may want to ask their healthcare provider the following questions:

  • How long will we be contagious?
  • How long should my child stay home from school?
  • How long should I stay home from work?
  • What steps can I take to ensure other family members don’t get infected?
  • What can I do to make myself or my child more comfortable?
  • What can I do to alleviate symptoms like an itchy rash or joint pain?
  • Should I notify my child’s school (or my work) about the infection?
  • How long will the rash last? Can it come back?
  • What signs of complications should I look out for?

A note from Cleveland Clinic

Even though fifth disease can look intimidating with its distinctive red rash, it’s usually a temporary condition that goes away with little treatment. But it’s important to understand that fifth disease can spread easily. If a member of your family has any of the symptoms of the condition, call your healthcare provider. You may need to keep your family member away from others for a little while to keep the virus from spreading.

Medically Reviewed

Last reviewed on 03/21/2023.

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