Symptoms of Fifth Disease (Slapped Cheek Disease)

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What is Fifth Disease?

Childhood illnesses marked with skin rashes used to be called first, second, and so on disease until they were properly labeled measles, scarlet fever, etc. Fifth disease got to keep its name, although it is medically known as erythema infectiosum.

This common childhood disease is caused by the human parvovirus B19 which is transferred directly by respiratory secretions and close physical contact.

Fifth Disease: Signs and Symptoms

Symptoms of Fifth disease often manifest a few days (four to fourteen days) after a person is exposed to the virus. Initially one may experience symptoms of flu like colds, runny nose, sore throat, fever and headaches. These symptoms may be mild and hardly noticeable to some. Adults may have joint pain and experience mild weakness. Others do not have symptoms at all. During this period the individual is infectious and can spread the airborne virus by sneezing, coughing, talking or using his contaminated hands.

After about a week with flu or cold symptoms, skin rashes appear. At this time the disease is not contagious anymore. These rashes have a distinctive appearance although some may not have rashes at all. If they appear, they may come in three stages:

  • A bright red rash on the cheeks similar to a slapped cheek appears which may spread to the forehead and chin. These may subside within two to five days.
  • A second stage of rashes appears, where pink to red spots in a lace-like pattern become visible on the child’s neck, trunk, forearms, upper legs and buttocks. These may be itchy and can last for a week.
  • After the rashes initially fade they may come and go when the child is exposed to heat or undergoes stress. This period is benign and may last from one to three weeks.

Adults, especially women, may experience joint pain in the hands, wrists, ankles and feet for one to three weeks. No permanent joint damage occurs.

In some people who have other medical conditions like sickle-cell disease or similar types of chronic anemia the symptoms of Fifth disease may be more serious. They may become severely pale and weak although the rashes may not appear. Usually the paleness resolves when the illness is controlled. In those patients who have a weakened immune system chronic anemia may develop and may need special medical care. These are usually patients who are suffering from leukemia, cancer or other serious diseases.

Except for those mentioned above, symptoms of Fifth disease are usually mild and respond to medications commonly given for symptoms of flu or colds. Children and adults get better within two to three weeks even without treatment.

Medical consultation may be needed if an infected child appears weak, has a loss of appetite or does not respond to symptomatic treatment. Proper diagnosis as to the type of infection may be necessary to differentiate other viral infections like measles and chicken pox.


WebMD, “Fifth Disease - Topic Overview”,

CDC, “Parvovirus B19 (Fifth Disease)”,