My seven-year-old came home from school with beet-red cheeks and a note from his teacher that said it looked like Fifth Disease. What’s that about? And should I worry about the sixth and seventh?
Wow! One of our grandchildren just had this problem. It was a week before Christmas and they were sent home from school with fever, cough, and bright-red cheeks. Turns out that this was the early stages of a city-wide outbreak of erythema infectiosum—more commonly know as “Slapped Cheek Disease” or Fifth Disease. We’ll talk about this “fifth” business in a moment, but first we need to understand this particular infection.
Slapped Cheek Disease is another of those problems whose name does a good job of describing the physical findings. This is caused by a Parvovirus (if you’re taking names) and most often occurs in outbreaks among school-aged children, though it can occur in adults as well. It’s very contagious and starts out with nonspecific symptoms, including fever, congestion, headache, and even nausea and diarrhea. Two to five days later, the classic bright-red rash appears on the cheeks. There may even be some pallor around the mouth, which can accentuate the facial rash. The incubation period—from the time of exposure to the onset of the rash—is usually one to two weeks, but can be as long as three weeks. The rash is what helps us with the diagnosis, and by the time it appears, your child is probably feeling better and is no longer contagious. That’s important to remember, since the rash can be impressive, even alarming. But at this stage, your child is no longer spreading the virus. That damage has already been done.
The good news is that this infection is almost always mild, and doesn’t lead to any significant complications. The treatment is supportive, with lots of fluids, rest, and ibuprofen or acetaminophen for fever or discomfort. The rash is going to last for a while—days to a week or so—but it will go away.
Isn’t there something I can put on his cheeks to make it go away quicker? Cortisone or something?
Nope. The rash is felt to be “immunologically mediated” (it’s coming from the inside) and no topical treatments are going to help. However, we need to be aware of a typical feature of these “slapped cheeks,” and that is the rash’s tendency to get worse with exposure to sunlight, a rising temperature, exercise, and even emotional stress. Not to panic, though. It’s going to go away.
Now why the name “Fifth Disease?” Nothing very exciting here. It turns out that this common viral exanthem (an infection with a rash) was the fifth such disease to be identified. The first four? Here they are:
- Rubeola – red measles
- Scarlet fever (also Scarlatina) – caused by a Strep infection and still seen today
- Rubella – German measles
- “Scalded Skin” disease – caused by a Staph infection. Some insert Chicken Pox in this position, since it also comes with a rash and is seen much more frequently than Scalded Skin.
- Fifth Disease (Slapped Cheek)
And yes, there’s a sixth disease—Roseola Infantum. Fortunately, we’ve stopped at six. There is no Seventh or Eighth disease. Not yet, anyway.
Add Comment