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Erythema infectiosum in Child
Other Resources UpToDate PubMed

Erythema infectiosum in Child

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed


Erythema infectiosum, or fifth disease, is a common illness in young children due to infection with parvovirus B19. Infection can result in a mild exanthem, no exanthem, or the typical "slapped cheeks" rash.

Children may have a prodromal headache with associated low-grade fever and rhinorrhea beginning 2 days before the onset of the rash. Children recover spontaneously without therapy.


B08.3 – Erythema infectiosum [fifth disease]

34730008 – Erythema infectiosum

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Differential Diagnosis & Pitfalls

  • Scarlet fever – Typically begins on the neck and trunk, then later involves the extremities. Patients also display signs and symptoms of streptococcal pharyngitis.
  • Erysipelas of the face – An acute beta-hemolytic group A streptococcal infection of the skin involving the superficial dermal lymphatics. Skin lesions have a distinctive raised, sharply demarcated advancing edge.
  • Cellulitis – Almost always unilateral.
  • Contact dermatitis – Usually is pruritic and asymmetric.
  • Kawasaki disease – Fever, foot and hand edema, conjunctival injection, lymphadenopathy, and genital area erythema. Kawasaki disease can present with red cheeks, as does fifth disease. Premature closure on fifth disease leading to missing Kawasaki disease is a diagnostic pitfall.
  • Tinea faciei
  • Rubella – Starts on the face and progresses caudad, covering the entire body in one day and resolving by the third day. Red macules or petechiae may be seen on the soft palate and uvula (Forchheimer's sign).
  • Roseola infantum – Three days of high fever followed by the appearance of a morbilliform erythema upon defervescence consisting of rose-colored macules on the neck, trunk, and buttocks. Mucous membranes are spared.
  • Rubeola (measles) – Is marked by the appearance of morbilliform lesions on the scalp and behind the ears that spreads to involve the trunk and extremities over 2-3 days. Koplik spots are pathognomonic and appear during the prodromal phase.
  • A careful history should help distinguish from a potential drug eruption.

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Last Updated:09/27/2020
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Patient Information for Erythema infectiosum in Child
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Contributors: Medical staff writer


Fifth disease (erythema infectiosum), also called slapped-cheek disease, is a common illness in young children due to infection with parvovirus B19. Fifth disease is spread by contact with others who are infected, specifically by exposure to fluid from the nose (respiratory secretions). The illness lasts approximately 5 days, but the rash may keep coming back for a few weeks, particularly with exercise, heat, fever, or stress. If a pregnant woman becomes infected, the infection can be harmful to the unborn baby. Fifth disease can also cause arthritis, although this is more commonly seen in infected adults.

Who’s At Risk

Fifth disease occurs all over the world. Lab studies show that about half of adults have been infected, although they may never remember being ill. The disease is common in pre-school and school-age children.

Signs & Symptoms

Bright redness of the cheeks is the classic initial sign, without affecting the areas around the mouth. About a day later, the rash shows up as a faint red, "lacy" rash on the trunk, arms, and legs. There may also be a fever or joint pain.

Self-Care Guidelines

If your child has fifth disease, it is not necessary to keep him or her away from other people because the infection is contagious before the rash appears, not after.

Notify any pregnant women who have been around your child that they have been exposed so they can notify their doctor.

You may give your child acetaminophen (Tylenol) or ibuprofen for fever or joint pain as needed.

When to Seek Medical Care

If your child has a weak immune system (from leukemia, a blood disease, or HIV/AIDS), notify the doctor if you suspect your child has fifth disease.


There is usually no need for testing, as the disease is easily recognized.

No treatment is required, as this illness will go away on its own.


Bolognia, Jean L., ed. Dermatology, pp.1260-1261. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.2054, 2057-2058. New York: McGraw-Hill, 2003.
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Erythema infectiosum in Child
A medical illustration showing key findings of Erythema infectiosum (Prodromal Stage) : Headache, Rhinorrhea, Low grade fever
Clinical image of Erythema infectiosum - imageId=105902. Click to open in gallery.  caption: 'Erythematous patches on the cheeks giving rise to the "slapped cheek" appearance.'
Erythematous patches on the cheeks giving rise to the "slapped cheek" appearance.
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