Erythema infectiosum

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Fifth disease, slapped-cheek disease, academy rash, Sticker's disease, Sticker disease


Childhood exanthem caused by human Par-vovirus B19, in which a 3-phased cutaneous eruption follows a mild prodrome


Parvovirus B19 viremia; production of specific immunoglobulin M (IgM) antibodies and subsequent formation of immune complexes; clinical findings probably result from the deposition of the immune complexes in the skin and joints

Clinical manifestation

4-14 day incubation period; virus spreads primarily via aerosolized respiratory droplets

Mild prodromal phase, including headache, coryza, low-grade fever, pharyngitis, and malaise

First stage: erythema of the cheeks, with nasal, perioral, and periorbital sparing (slapped-cheek appearance) and fades over 2-4 days

Second stage: within 1-4 days of the facial rash, erythematous macular-to-morbilli-form eruption occurs primarily on the extremities

Third stage: after several days, most of the second stage eruption fades into a lacy pattern, particularly on the proximal extremities; lasts from 3 days to 3 weeks; after starting to fade, exanthem sometimes recurs over several weeks following exercise, sun exposure, friction, bathing in hot water, or stress; adults sometimes develop polyar-thropathy

Differential diagnosis

Other viral exanthems; medication reaction; Lyme disease; lupus erythematosus;

acute rheumatic fever; allergic hypersensitivity reaction


Antihistamines, first generation, as sedative and mild anti-pruritic agent


Koch WC (2001) Fifth (human parvovirus) and sixth (herpesvirus 6) diseases. Current Opinion in Infectious Diseases i4(3):343-356

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