Although the rash of slapped cheek disease can be quite impressive, it is a common childhood illness which is generally mild in children. Slapped cheek syndrome or Slapped cheek disease is also known as erythema infectiosum or Fifth disease.


What is Slapped Cheek?

Slapped cheek is caused by a virus called parvovirus B19.

It is a common childhood illness which generally occurs in school-age children but can occur at any age and tends to around more in the spring.

The incubation period of slapped cheek disease is 4 to 20 days (generally 4 to 14 days), meaning that you can be exposed to the virus and not develop symptoms until 4 to 20 days later.

Approximately 5 or 6 out of 10 adults have been exposed to parvovirus and have immunity.

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What are the key signs and symptoms?

The classic symptom is a bright red rash – less obvious on black or brown skin than on white skin – on one or both cheeks: the name slapped cheek disease comes from the appearance of the rash on the cheek(s) – it does look like someone's just been slapped around the face!

Although it can look quite dramatic, it can also look more blotchy.

There may also be a generalised rash over the rest of the body.

The rash is not itchy or painful.

Before the rash appears, your child may be unwell with symptoms such as a fever, headache and sore throat.

About a week to 10 days later the rash can appear, and by the time it does, your child is no longer infectious.

But not everyone will develop symptoms: in fact about 1 in 4 people are asymptomatic, so you can have been exposed and therefore have immunity but not know it.

How do I know the rash is Slapped Cheek and not measles?

It isn't always easy to differentiate rashes but the rash and symptoms of slapped cheek are different to measles, in that children with measles may be more unwell, with a higher fever, sore red eyes and small grey/white spots inside the cheeks, followed a few days later by a blotchy rash which starts on the head and spreads to rest of the body.

Measles can also be prevented with the MMR vaccination; there is currently no vaccination against the parvovirus which causes slapped cheek syndrome.

What should I do if I think my child has Slapped Cheek?

There is no specific treatment for slapped cheek disease, but make sure that your child is well hydrated and use age-appropriate doses of either paracetamol or ibuprofen if required.

Do I need to keep my child off nursery or school?

If your child has a fever and is unwell they should be kept at home. Once the rash has developed, they are no longer infectious and can return to school. However it is important to inform the school so that staff members can take appropriate action if they are pregnant (see Is slapped cheek something to worry about in pregnancy?, below).

How long does it last for?

The incubation period of slapped cheek syndrome, the time from exposure to symptoms is 4 to 20 days. Then if symptoms develop there tends to be about a week to 10 days before the rash generally fades – though it can last up to a month or so.

More rarely, slapped cheek syndrome can also cause joint pains and stiffness, though this is commoner in adults than children. Even after the other symptoms have resolved, joint pain and stiffness can remain for weeks.

Is Slapped Cheek something to worry about in pregnancy? What do I need to know?

If you are pregnant and are exposed, seek medical advice. Most pregnant women will not be seriously unwell but if you have the infection before 20 weeks of pregnancy, miscarriage is more of a risk.

In this situation, your doctor is likely to request a blood test to see if you have antibodies and therefore immunity to parvovirus. If you don’t have immunity then the antenatal team will be informed and they may request other tests such as an ultrasound scan.

Images: Science Medical Library

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Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice.