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Fifth Disease-Viral Rash


  • Viral rash that starts with red cheeks and spreads to the shoulders

Symptoms of Fifth Disease

  • Bright red cheeks on both sides for 1 to 3 days. Looks like "slapped cheeks".
  • Followed by pink "lace-like" (net-like) rash of arms and legs.
  • "Lacy" rash mainly is on thighs and upper arms/shoulders.
  • Rash also is on chest and stomach in 50% of children.
  • The rash does not itch or hurt.
  • No fever or low-grade one less than 102° F (39° C).
  • Peak age: 4 -12 years.

Cause of Fifth Disease

  • It is caused by the human parvovirus B19.
  • Not related to the dog parvovirus.

Prevent Spread to Others

  • Good hand washing can prevent spread of this illness.
  • Once the rash occurs, the child can no longer spread the virus.

When To Call

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Only 1 cheek is red and also has fever
  • High Risk child (such as those with a chronic medical problem or weak immune system)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Fever higher than 102° F (39° C)
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Sore throat lasts more than 48 hours
  • Mother or other caregiver is pregnant
  • You have other questions or concerns

Self Care at Home

  • Fifth disease suspected

Care Advice

What You Should Know About Fifth Disease:

  • It is a viral rash that is harmless.
  • It does not itch or hurt.
  • It can be treated at home.
  • Here is some care advice that should help.

Fever Medicine:

  • For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Note: fevers less than 102° F (39° C) are important for fighting infections.
  • For all fevers: keep your child well hydrated. Give lots of cold fluids.

Pregnant Women - Special Risk:

  • The risk of Fifth disease is to the unborn babies of pregnant women. It is not harmful to the woman herself.
  • A pregnant woman should see her doctor if she is exposed.
  • He will do a test to see if the mother has had the disease. If she has, she is protected.
  • If not, the pregnancy will need to be watched closely. Some babies that get it before birth can have problems. Ten percent can have a very low red blood cell count and 2% may die.
  • But, birth defects are never a result of this virus.

What to Expect:

  • The lace-like rash can come and go for 1 to 3 weeks.

Return to School:

  • Once your child has the "slapped cheeks," they can no longer spread the illness. Also, the lacy rash cannot be spread to others either.
  • Your child does not need to stay home from child care or school.
  • It can be spread during the week before the rash begins.
  • Exposed children should try not to have any contact with pregnant women. This may be hard to know ahead of time.

Call Your Doctor If:

  • Fever higher than 102° F (39° C) occurs
  • You think your child needs to be seen
  • Your child becomes worse



Fifth disease

There is redness and puffiness of both cheeks; this is the first sign of Fifth's Disease.

Source: CDC PHIL
From the CDC's Public Health Image Library (, ID#4510, in the public domain.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
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