Symptoms of 5th Disease (Erythema Infectiosum)
Fifth disease presents classically with a distinctive "slapped cheek" facial rash followed by a lacy, reticulated rash on the trunk and extremities, typically preceded by mild prodromal symptoms in school-aged children. 1
Prodromal Phase
The initial symptoms appear after an incubation period of 4-14 days and are typically mild: 1
- Low-grade fever (though can occasionally exceed 102.2°F/39°C) 1
- Headache 1
- Malaise and general discomfort 1
- Myalgia (muscle aches) 1
Many infected individuals remain asymptomatic or have only nonspecific cold-like symptoms without developing the characteristic rash. 2
The Three-Stage Rash Evolution
Stage 1: Facial Erythema
- Bright red erythematous rash on both cheeks creating the pathognomonic "slapped cheek" appearance 1, 2
- This facial rash is the hallmark initial presentation in children 1
- In adults, only approximately 20% develop this facial rash, making diagnosis more challenging 1
Stage 2: Body Rash
- The rash spreads concurrently or rapidly to the trunk, extremities, and buttocks as diffuse macular erythema 1
- More intense on extensor surfaces of the limbs 1
- Palms and soles are typically spared 1
- Central clearing produces a characteristic lacy or reticulated pattern that distinguishes fifth disease from other exanthems 1
- In adults, the rash appears more frequently on legs first, followed by trunk and arms, with the reticulated pattern present in 80% of cases 1
Stage 3: Evanescence and Recrudescence
- The rash characteristically fades and recurs over subsequent weeks 1
- Recurrence can be triggered by sunlight, heat, exercise, or emotional stress 1
- Pruritus occurs in approximately 50% of cases 1
- The rash typically resolves spontaneously within three weeks without sequelae 1
Age-Related Presentation Differences
Children (4-10 years most commonly affected): 1
- Classic "slapped cheek" appearance is prominent 1
- Rash is more pronounced and follows typical three-stage pattern 1
Adults: 1
- Facial rash is less common and often atypical 1
- Arthralgia and arthritis are more prominent than rash 3, 2
- Joint symptoms can persist for weeks to months 2
Critical Timing Consideration
By the time the characteristic rash appears, the patient is no longer infectious, as the virus spreads primarily during the prodromal phase through respiratory droplets. 2 This has important implications for isolation precautions and exposure risk assessment.
Atypical Presentations
Some patients develop papular-purpuric "gloves and socks" syndrome (PPGSS), characterized by: 4