• Dr Andy Raffles

Slapped Cheek?!

You may have received a letter from the nursery or school saying that there has been an outbreak of Slapped Cheek Disease but what is this? Slap Cheek is a common name for erythema infectiosum or Fifth Disease (the fifth childhood disease with a rash to be discovered). It is caused by parvovirus B19 and is a mild illness, that is most common in children between 5 and 14 years of age, but it can occur in younger children and adults. Between 4 and 14 days after a child is exposed to the virus, they will usually have symptoms which might include fever, headache, muscle aches, sore throat, runny nose, tiredness, tummy ache, etc. These mild symptoms usually last for 2 or 3 days and it is only during this period that the child is contagious. This is followed by a period of about one week during which most children are free of symptoms, before the rash part of the illness begins. Because there is a long period of time between the various symptoms and the rash, people often don’t link the two phases. The rash phase of the illness, usually occurs in 3 stages. The first stage is characterised by a bright red rash on the cheeks, which gives rise to the name slap cheek. It is most noticeable when the child goes from a cool environment into a warm one. It usually only lasts 24 to 48 hours. The second stage of the rash occurs 1 to 4 days later, with the appearance of a less intense rash on the trunk and limbs. Towards the end of this stage, which may last up to a week, there is a blotchy clearing of the rash, leaving a lacy pattern. The third stage of the rash usually lasts for longer than a week and can go on for a month or more. It is characterised by coming and going of the intensity of the second phase rash. These fluctuations are most marked when the child is hot. A child can appear to be completely recovered, only to have the rash reappear when she takes a bath. The whole process can last one month, but your child will only infect others in the period when they have the symptoms, not during the period of the rash. There is no treatment for erythema infectiosum. Occasionally the rash itches, or the joints ache. If this is the case, treatments such as oatmeal baths, paracetamol or ibuprofen can be helpful. Be reassured complete recovery is normal. It is right that slap cheek is quite contagious, with cases following each other by four to fourteen days, but while the rash is present, the child is not contagious at all! There should be no problem in returning to school or nursery day care. Pregnant women who have been exposed to slap cheek should discuss this with their Obstetrician. Most of babies born to mums who develop Fifth Disease in pregnancy do well, but the pregnancy should be monitored.

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