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Slapped cheek syndrome: Picture, symptoms, diagnosis and treatment

Slapped cheek syndrome, sometimes also called fifth disease, is a mild to moderately contagious viral infection common among school children aged three to 15, occurring particularly in the winter and early spring. It is called slapped-cheek syndrome because of the characteristic initial red marks on the face in children.

 Picture of Erythema Infectiosum

Although it can resemble other childhood rashes, such as rubella or scarlet fever, slapped cheek syndrome usually begins with the distinctive, sudden appearance of bright red cheeks that look as if the child has been slapped. The disease is rare in infants and adults.

Slapped cheek syndrome is usually mild. It is spread by respiratory droplets that enter the air when an infected person coughs or sneezes, or through blood. It poses little risk to healthy children and adults, but pregnant women without immunity to slapped cheek syndrome have an increased risk of miscarriage because it can cause anaemia in the unborn baby.

What causes slapped cheek syndrome?

Slapped cheek syndrome is caused by parvovirus B19 and is spread by respiratory secretions from an infected person. By the time the rash appears, children are no longer infectious. The incubation period (the period between infection and signs or symptoms of illness) is usually four to 14 days, but can be as long as 21 days.

Adults who work with young children such as childcare providers, teachers, and those in healthcare fields are most likely to be exposed.

 

What are the symptoms of slapped cheek syndrome in children?

  • High temperature (fever) of 38C (100.4F)
  • Bright red cheeks
  • A flat or raised red rash, usually on the arms and legs, which lasts from two to 39 days and may itch. The rash fades from the centre of red areas towards the edges, giving it a lacy appearance. The rash can recur after exercise, warm baths, rubbing the skin or emotional upset.
  • Less commonly, headache, sore throat and joint pain

Not all children with slapped cheek syndrome develop the rash. Conversely, parents of some children may become concerned if the rash lasts several weeks or fluctuates with environmental factors, such as exercise and warm baths. Both are normal.

The following symptoms are more frequent and more severe in adults with parvovirus B19 infections, and they generally precede the rash, which often does not occur in adults, by seven to 10 days:

  • Headache
  • Sore throat
  • Muscle pain
  • Joint pain
  • Abdominal pain
  • Fever

Most foetuses are unaffected when their mothers contract the virus, and it has not been proven to cause birth defects. However, if a foetus becomes infected, the virus can disrupt the foetus's ability to produce red blood cells, leading to a dangerous form of anaemia, heart failure, and sometimes miscarriage or stillbirth.

Seek medical advice about slapped cheek syndrome disease if:

  • Your child has  sickle cell anaemia, any other chronic anaemia, or an impaired immune system and has been exposed to fifth disease or is exhibiting symptoms.
  • You are pregnant, you do not know whether you are immune to parvovirus B19 - or know that you are not immune - and you come into contact with anyone who has an infection with parvovirus B19.
  • The rash becomes purple, painful, or blistered or lasts longer than five weeks.
  • Your infected child appears to be very ill.
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