Fifth Disease, Roseola and Other Childhood Viral Rashes: What They Look Like and When to Worry

Fifth disease and roseola are two of the most common viral rashes in young children, and both are usually mild. Fifth disease causes bright red "slapped" cheeks, then a lacy rash on the arms and legs, and by the time the rash appears, the child is no longer contagious. Roseola causes three to five days of high fever, then a pink, spotty rash on the body as the fever breaks. Neither needs antibiotics. A rash that doesn't fade when pressed, or a child who seems very unwell, needs to be seen right away.

Fifth disease (slapped cheek)

Caused by parvovirus B19, most common in school-age children in late winter and spring.

• First: mild cold symptoms, low fever, headache
• Then, about a week later: bright red cheeks that look slapped
• Then: a lacy, net-like rash on the arms, legs and body that can come and go for weeks, especially with heat or sun
• In adults: often joint pain and swelling in the hands, wrists and knees instead of the cheek rash

Children are contagious before the rash, during the cold-like phase. Once the rash appears, they can go back to school.

Fifth disease and pregnancy

Most adults are already immune. In pregnancy, a new infection can rarely affect the baby. If you're pregnant and have been around someone with fifth disease, tell your OB-GYN or midwife; a blood test can check your immunity.

Roseola

Caused by human herpesvirus 6 or 7, most common between 6 months and 2 years.

• First: a sudden high fever, often over 103°F, for three to five days. The child may be fussy but often acts surprisingly well.
• Then: as the fever goes away, a rash of small pink spots, mainly on the chest, back and belly, that fades within a few days
• Some children have a febrile seizure with the high fever. It's frightening, but usually harmless.

Roseola spreads through saliva and is contagious during the fever, before the rash appears.

Other common viral rashes

• Hand, foot and mouth disease: mouth sores and spots on the hands and feet. See our hand, foot and mouth post.
• Viral rashes with colds: blotchy pink rashes that come with or after many common viruses
• Chickenpox: itchy blisters in crops, now rare thanks to the vaccine
• Measles: high fever, cough, red eyes, then a rash starting at the hairline. Measles is very contagious; call ahead before coming in so we can protect other patients.

What helps

• Acetaminophen or ibuprofen for fever and discomfort, dosed by weight (no ibuprofen under 6 months, no aspirin for children)
• Fluids and rest
• Lukewarm baths and loose clothing for an itchy rash

When to get seen

Come in for a high fever that lasts more than three days, a fever in a baby under 6 months, a rash with a fever you're unsure about, or joint pain with a rash in an adult. A clinician can usually tell these rashes apart by looking and asking a few questions. At an AfterOurs clinic, a standard self-pay visit is $175, and a self-pay in-clinic visit never costs more than $330. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our rashes and fever pages and the cost and insurance page. Our fever post explains which temperatures matter at each age.

Go to the ER or call 911 if a rash has purple or red spots that don't fade when you press a glass against them, especially with a fever; if a child is hard to wake, floppy, or has trouble breathing; if a baby under 3 months has a fever of 100.4°F or higher; or if a seizure lasts more than 5 minutes.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

Walk in, or book online.