That Rash Could Be Fifth Disease: Photos, Stages, and Treatments

Fifth disease (also called erythema infectiosum) is a common childhood viral infection. The illness got its name in the early 1900s. Back then, scientists didn’t know which viruses and bacteria caused different infections. So they named the most common childhood infections that caused rashes with numbers. Erythema infectiosum was fifth on the list, and the name is still used today, even though the other rashes go by their “proper” names. 

Most people recover quickly from fifth disease. But people who are pregnant or have certain medical conditions can develop more serious symptoms. 

What are the symptoms of fifth disease?

The first symptoms of fifth disease include flu-like symptoms like:

• Low-grade fever

• Sore throat

• Cough

• Runny nose

• Sneezing

• Conjunctivitis (“pink eye”)

• Headache

• Feeling tired 

• Muscle aches

• Upset stomach (diarrhea, nausea, or vomiting)

• Joint pain in hands, wrists, knees, and feet (more common in adults, less common in children)

After a few days, a rash develops on the face. The rash looks bright red on fairer skin tones and brown or purple on darker skin tones. At first, the rash is most pronounced on the cheeks, but over days, it can spread to the arms, legs, and torso. 

What are the stages of fifth disease?

The symptoms of fifth disease typically come in three stages:

• First stage: During this stage, children can have fever, headache, runny nose, and muscle and joint pain. This is when they are most contagious.

• Second stage: About 2 to 5 days after first-stage symptoms start, children develop a rash over the face — the typical “slapped-cheek” rash. It can look like a sunburn or windburn. Once children reach this stage, they’re no longer contagious and can go back to school. 

• Third stage: Several days later, most children develop a rash over the rest of their body. The rash is usually red in fairer skin tones, with a lace-like pattern. In darker skin tones it may look violet, brown, and raised. The rash can be itchy, but by the time it appears, children usually feel back to normal. The rash usually goes away on its own over 1 to 2 weeks. 

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Images of fifth disease

Here’s what a fifth disease rash looks like in different stages and skin tones. 

The second stage of fifth disease manifests as a rash on the cheeks, also known as “slapped-cheek” rash.

A child has fifth disease rash on the face and body.

The third stage of fifth disease presents as a rash on the rest of the body, in this case, on the leg.

A child has lace-like rash on their torso and arms during the third stage of fifth disease.

What causes fifth disease?

Fifth disease is caused by a virus called parvovirus B19. Parvovirus B19 is a respiratory virus like the viruses that cause COVID-19 and the flu. It spreads from person to person through respiratory droplets produced when people talk, cough, or sneeze. 

Like other respiratory viruses, parvovirus B19 can pass easily between people. Outbreaks can develop very quickly, especially in places where people spend time close together, like in households and schools.

The virus tends to be more active from late winter to early summer. So outbreaks of fifth disease are more likely to happen during spring months. 

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Can adults get fifth disease?

Yes. But adults are less likely to get sick than kids. That’s because most were exposed to parvovirus as children, so they have protective antibodies. Adults with fifth disease are less likely to get a rash, and more likely to get joint swelling and pain.  

How is fifth disease diagnosed? 

Most of the time, a healthcare professional can diagnose fifth disease just by looking at a child’s rash and reviewing their symptoms. If the diagnosis isn’t clear, a blood test can be done to confirm parvovirus B19. 

How is fifth disease treated?

Children and adults get better on their own from fifth disease. There’s no specific medication that treats fifth disease. But there are things you can do to help a child feel better as their immune system fights off the infection. These include:

• Over-the-counter (OTC) pain and fever relievers like acetaminophen or ibuprofen

• Drinking plenty of fluids to avoid dehydration

• Getting plenty of rest and sleep

• Using OTC itch relief creams or antihistamine medicine like diphenhydramine (Benadryl)

What to do if you’re pregnant and are exposed to fifth disease?

Rarely, people who are exposed to parvovirus B19 in pregnancy can have a miscarriage or other complications of pregnancy. But this isn’t common. If you’re pregnant and you’ve been exposed to parvovirus, or you think you could have fifth disease, call your primary care provider or your obstetrician’s office right away. They can check your antibody levels to see if you are immune to parvovirus. They may also increase your monitoring for the rest of your pregnancy. 

People at high risk of serious illness with fifth disease

People with a weakened immune system and people with certain blood disorders can develop more serious illnesses from a parvovirus infection. Call your primary care provider or other medical team right away if you have one of the following medical conditions, and you think you were exposed to fifth disease — you may need specialized treatment:

• Cancer being treated with chemotherapy 

• Any previous solid organ transplant (like a kidney or liver)

• Weakened immune system (from medication or another cause)

• Sickle cell disease

• Alpha thalassemia

• Spherocytosis

• Autoimmune hemolytic anemia

• HIV 

What can you do to prevent fifth disease?

There’s not much you can do to prevent the spread of parvovirus and fifth disease. There are two reasons for this: 

• It can take up to 2 weeks to develop symptoms of fifth disease after being exposed to the virus. You are most infectious before you develop the facial rash. 

• Many people never develop any symptoms at all, so they don’t know they have the infection. 

But if you know there’s an outbreak in your community or school, there are measures you can take to help prevent the spread of parvovirus B19. These are the same things you would do to prevent getting any highly contagious infection: 

• Wash your hands and use hand sanitizer regularly.

• Make sure to cover your mouth when coughing or sneezing.

• Avoid touching your face, mouth, and eyes with unwashed hands.

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Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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