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Skin Rash: Fifth’s Disease

by Sue Hubbard, M.D.

Even though it already feels like summer across many parts of the nation, I’m still seeing typical spring illnesses like Fifth’s disease.  Fifth’s disease is a common viral illness seen in children, often in the late winter and spring.

fifthsphotoMany of these children look like they have gotten a little “sunburn” on their faces as they often show up with the typical “slapped cheek” rash on their faces.  At the same time they may also have a lacy red rash on their arms and legs, and occasionally even their trunks. Fifth’s is also called erythema infectiosum and is so named as it is the fifth of six rash associated illness of childhood.

Fifth’s disease is caused by Parvovirus B19, which is a virus that infects humans. It is NOT the same parvovirus that infects your pet dog or cat, so do not fear your child will not give it to their pet or vice a versa.

In most cases a child may have very few symptoms of illness, other than the rash.  In some cases a child may have had a low-grade fever, or runny nose or just a few days of “not feeling well’ and then the rash may develop several days later. The rash may also be so insignificant as to not be noticed.

When I see a child with Fifth’s disease it is usually an easy diagnosis based on their few symptoms and the typical rash. Although children with Fifth’s are probably contagious at some time during their illness, it is thought that by the time the rash occurs the contagious period has passed. This is why you “never know” where you got this virus. (the incubation period is somewhere between 4-20 days after exposure).

Parvovirus B19 may be found in respiratory secretions and is probably spread by person to person contact.  During outbreaks it has been reported that somewhere between 10 – 60% of students in a class may become infected. Most adults have had Fifth’s disease and may not even have remembered it, as up to 20% of those infected with parvovirus B19 do not develop symptoms, so it is often not a “memorable” event during childhood.

Fifth’s disease is another one of those wonderful viruses that resolves on its own. I like to refer to the treatment as “benign neglect” as there is nothing to do!  The rash may take anywhere from 7–10 days to resolve.

I do tell parents that the rash may seem to come and go for a few days and seems to be exacerbated by sunlight and heat. So, it is not uncommon to see a child come in from playing on a hot sunny day and the rash is more obvious on those sun exposed areas.  Occasionally a child will complain of itching, and you can use a soothing lotion such as Sarna or even Benadryl to relieve problematic itching. A cool shower or bath at the end of a hot spring/summer day may work just as well too.

Children who are immunocompromised, have sickle cell disease, or have leukemia or cancer may not handle the virus as well and they should be seen by their pediatrician. But in most cases there is no need to worry about Fifth’s disease, so it is business as usual with school, end of year parties, and summer play dates!

That’s your daily dose for today.  We’ll chat again tomorrow!

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2 Responses to “Skin Rash: Fifth’s Disease”

  1. Michael says:

    this is a great post

  2. Julie N. says:

    Very timely for our family! Our 5 year old is getting over his case of Fifth’s Disease. Must be a late outbreak in our area. I know exactly when he was exposed, and the incubation period was longer than we expected. He is doing well, though. We did avoid a family gathering today where we have several pregnant in-laws. Better to be safe than sorry and have one of the girls and their babies have issues.

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