Fifth disease, or slapped cheek syndrome, can cause a bright red rash on one or both cheeks while the rest of the face is pale. On darker skin, it may be harder to see.

Fifth disease, known medically as erythema infectiosum, results from infection with the parvovirus B19. It is one of the five most common viral diseases in children, along with measles, rubella, chicken pox, and roseola.

Fifth disease mainly affects children aged 5–15 years. Less commonly, adults can also develop it. However, they are less likely to have a rash.

Other symptoms may include a mild fever, aches, joint pain, and a general feeling of being unwell, known as malaise. The rash usually last around 4–5 days and a person will usually feel better within 3 weeks.

Fifth disease is usually a mild illness that goes away on its own. However, it can be more serious during pregnancy and for people with certain health conditions.

This article will explain how to recognize fifth disease and what to expect, particularly regarding rashes.

The symptoms of fifth disease usually appear within 14 days of exposure to parvovirus B19. They may include two types of rash.

Most children with fifth disease will have a rash. However, fewer than half of adults with the infection will have one.

Facial rash

The first type of rash to appear is a red rash across the cheeks known as a malar or “butterfly” rash. It is less common in adults and usually affects children aged 5–15 years who have the virus.

On pale skin, the rash can make the cheeks look bright red, which is why some people call it slapped cheek syndrome. The rash may be harder to see on darker skin tones.

The facial rash tends to last 4 or 5 days. However, a person may continue to feel unwell with other symptoms for up to 3 weeks.

What does a roseola rash look like?

Rash on the trunk and limbs

Some days after the facial rash appears, some people also develop a rash in the chest, back, arms, buttocks, and legs. It does not usually affect the palms of the hands or soles of the feet.

The body rash involves papules or bumps and may be itchy, especially in adults. On lighter skin, it may show as purplish, pink, or red. However, it may be harder to see on darker skin. As it goes away, it might look lacy.

According to the Centers for Disease Control and Prevention (CDC), this second rash will usually go away in 7 to 10 days. However, it can come and go for several more weeks.

What to know about viral rashes adults and children.

As well as a rash, a person may experience flu-like symptoms. These usually appear before a rash.

Joint pain may occur as the virus progresses, and it can appear without other symptoms. It usually lasts 1–3 weeks. However, can last longer. It tends to affect joints symmetrically, for instance, both hands, feet, wrists, knees, and feet.

Parvovirus B19 affects the way the body makes red blood cells, and it can lead to complications, such as anemia, in people with sickle cell disease or a weakened immune system.

In rare cases, fifth disease can cause problems during pregnancy. Anyone at risk of parvovirus B19 infection during pregnancy should speak to a doctor.

Fifth disease tends to have three overlapping stages:

  • Within 2 weeks of exposure to the virus, a person feels unwell, possibly with a fever, muscle aches, headache, vomiting, or diarrhea.
  • A face rash appears and lasts 4–5 days. When the rash is present, the person can no longer pass on the virus.
  • A body rash may appear and usually lasts around a week. It may be itchy in adults.

Joint symptoms may last beyond the rash and other symptoms. A person with joint symptoms cannot pass on the virus.

Infection with parvovirus B19 causes fifth disease. The virus mainly spreads through the droplets of saliva, sputum, or nasal mucus a person expels when they cough or sneeze.

The virus can also pass on through blood during pregnancy to a fetus.

Experts believe the rash is immune-mediated, which means it occurs as the immune system reacts to fight the virus.

People with fifth disease are most likely to pass on the virus during the first stage of the illness. Once a rash or joint pain appears, the virus is no longer infectious.

Doctors will usually diagnose fifth disease by looking at the rash and asking about symptoms.

In some cases, a doctor may suggest an antibody blood test. Tests can usually detect antibodies in the blood 7–10 days after exposure to the virus. This may be useful if a person has a weakened immune system or during pregnancy.

There is no specific treatment for fifth disease, and it will usually resolve alone within around 2 weeks. However, home and over-the-counter treatment can help manage symptoms and discomfort.

Options include:

Most people do not need to see a doctor with fifth disease.

However, anyone who has or may have fifth disease should seek medical advice if they:

  • have a blood disorder or weakened immune system
  • are pregnant
  • have symptoms that persist or worsen over time
  • are a child and develop joint pain

Fifth disease is a viral rash that mostly affects children. However, it can occur in adults. It can cause a rash on the cheeks followed by a rash on the body.

It results from infection with parvovirus B19 and is most common in the spring. Other names for fifth disease include erythema infectiosum or slapped cheek syndrome.

Fifth disease is usually mild and goes away on its own. However, over-the-counter medications and home remedies can help manage symptoms. Moisturizing creams and antihistamines may help with a rash.

Anyone who has a blood disorder, a weakened immune system, or who is pregnant and who may have fifth disease should speak with a doctor.