Erythema Infectiosum

February 8, 2017

Eythema infectiosum is also known as parvovirus infection, slapped cheek disease, or fifth disease is a viral infection. A virus called Parvovirus B19 causes fifth disease. Parvovirus B19 can spread from person to person. It spreads through droplets in the air or on surfaces we touch. Its symptoms include low-grade fever, tiredness, rash on the cheeks (hence “slapped cheek”), and also a rash all over the person’s body.

It is also called fifth disease because it used to be 5th among a common group of childhood diseases with similar rashes – after measles, rubella (German measles), scarlet fever and Dukes’ disease.

Parvovirus continues to be a common childhood infection which tends to be mild and requires either very little or no treatment. If a pregnant woman has a parvovirus infection there is a risk of serious health problems for the developing fetus. Patients with a weakened immune system, as well as those with some types of anemias are at a higher risk of complications. Slapped cheek syndrome only affects humans, although some types of parvovirus can affect animals. The virus cannot jump from animal-to-human or human-to-animal.

There are many types of erythema, including photosensitivity, erythema multiforme, and erythema nodusum. Photosensitivity is caused by a reaction to sunlight and tends to occur when something, such as an infection or a medication, increases your sensitivity to ultraviolet radiation. Erythema multiforme is characterized by raised spots or other lesions on the skin. It is usually caused by a reaction to medications, infections (especially herpes simplex virus), or illness.

A person usually gets sick with fifth disease within 4 to 14 days after getting infected with parvovirus B19.


Erythema infectiosum is caused by a virus called parvovirus B19.

The virus is transferred from one person to another via airborne droplets from the nose and throat, for example when coughing or sneezing.

An infected pregnant woman can transfer the virus to her unborn baby.

The incubation period for parvovirus B19 is between one and three weeks and the person will be infectious for about a week before the illness actually becomes apparent.

By the time symptoms are present, the person is no longer infectious. There are 50 to 80 per cent of adults who have been infected with B19.

Risk Factors

  • Pregnant women who have not had the disease before.
  • People with a lowered immune defense system.
  • People with chronic anaemia.


Signs of the illness can be quite apparent, but are not always present in all infected individuals. Look out for the following tell-tale signs –

  • At the beginning, symptoms may resemble common cold signs, including headache, general malaise and fever.
  • Within seven to 10 days, a characteristic rash can develop starting on the face (referred to as slapped cheeks). Sometimes, a lace-like rash, often itchy, can develop on the body and involve the arms, buttocks, and thighs.
  • The rash may disappear and then reappear after exposure to heat (i.e. after a bath or shower), sun exposure or after exercising for weeks. However, some children can be infected without ever exhibiting such symptoms.

The following signs and symptoms are possible –

  • Slightly elevated body temperature
  • Fly-like symptoms
  • Runny nose
  • Stuffy nose
  • Fatigue
  • Sore throat
  • Nausea and/or diarrhea (less common)
  • Abdominal pain (less common)
  • Joint pain (less common, usually just in adults)
  • Neurological problems (very rare, and if so, just in adults)
  • Cardiovascular problems (very rare, and if so, just in adults)
  • Blotchy red rash appears on the cheeks. The rash may be itchy, but is very rarely painful.
  • The rash may spread to the body, limbs and the palms of the hands and soles of the feet. The rash may take up to three weeks to go away. Some patients may experience a recurrence of the rash if they are exposed to heat or sunlight.


  • Polyarthropathy in infected adults (painful, swollen joints)
  • Aplastic crisis or potentially dangerous low blood cell count in patients with haemolytic blood disorders such as autoimmune haemolytic anaemia and sickle cell disease
  • Spontaneous abortion, intrauterine death (9%) or hydrops fetalis in 3% of the offspring of infected pregnant women. This can occur if erythema infectiosum occurs in the first half of pregnancy. Parvovirus B19 does not cause congenital malformations. As the risk of an adverse outcome is low, the infection is not routinely screened for in pregnancy
  • Chronic parvovirus infection in immunodeficient patients, such as organ transplant recipients, causing erythropoietin-resistant anaemia, proteinuria, and glomerulosclerosis in a renal allograft
  • Rarely, encephalitis, hepatitis, non-occlusive bowel infarction, amegakaryocytic thrombocytopaenia, myositis and heart disease



  • Antihistamines for itching
  • Antibiotics – If a person has an infection, though research suggests many cases of erythema can be resolved without antibiotics
  • Antiviral medications such as acyclovir and valacyclovir,
  • Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Burrow’s compresses, a solution used to soothe skin conditions, particularly blisters
  • Corticosteroids, applied to the skin (topically); corticosteroids may also be taken orally to reduce symptoms of erythema nodosum
  • Intravenous immunoglobulin, used experimentally for SJS and TEN
  • Photomodulation therapy, use of a light-emitting diode to accelerate the resolution of erythema

Complementary & Alternative Treatment

Beta-carotene and other carotenoids is often used as a standard treatment for sun sensitivity, although studies have been mixed.

Vitamin B6 help reduce the reaction.

Vitamin C is an antioxidant, so it may provide some protection against skin damage.

Vitamin D help for the sky.

Melatonin: Applying melatonin topically (either alone or in combination with vitamin E) seems to offer some protection against the reaction.

Zinc is necessary for healthy skin and was used in a study along with other prescription medications as a treatment for a severe form of erythema.

Flavonoids – Some of these plant-based antioxidants may protect skin from sun damage in healthy people.

Aloe vera – Used topically for skin inflammation

Goldenseal – Used for infections, including those causing skin lesions.

Sage extract – Applied topically to reduce inflammation.


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