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Fifth disease is generally mild

Drew Werner

The black plague, scarlet fever, leprosy, rubella, rubeolla, small pox, pemphigus, ebola, hand-foot-mouth disease – the list goes on. What do they all have in common? Each is a disease, illness or infection that causes some type of skin rash.

Warts, chicken pox and shingles are all more common conditions you may have seen. Since the dawn of time, any condition that causes our skin to break out has been feared and avoided “like the plague.” In early times, the panic such illnesses raised was partially justified. People didn’t understand how things were transmitted. Even worse, once acquired, there was little to be done.



Despite advances in medicine, similar problems continue to raise alarm, perhaps still for good reason.



Dear Doc: There has been an outbreak in my school of something called fifth disease. Should I be concerned? Is it dangerous? Are all the children at risk?

– A concerned teacher in Edwards



Dear Concerned: Good question. Infections with a rash are a natural cause for alarm. They often signal contagiousness and may be a harbinger of an outbreak or epidemic. Especially in close environments like schools, institutions and the military, the rate of spread can be alarming. Not all is a worry, however. Careful hand washing and early recognition can play significant roles in keeping the mole hill a mole hill.

So, what is fifth disease? It is a contagious viral illness generally much more common in children than adults. A virus called the human parvovirus B19 causes it. Like many viruses, it is spread by contact with respiratory droplets from coughing, sneezing and runny noses. (Now we know why mom always told us to wash our hands.)

The illness develops about four to 14 days after exposure and has flu-like symptoms. A runny nose, sore throat, headache, fevers to 102 degrees and body aches are common. Most striking however is a typical rash that occurs in 50 percent of those infected.

Usually five to seven days after the onset of symptoms, a bright red rash may show up on the cheeks. This is referred to as a “slapped cheek” rash. It looks like just that, or perhaps in a kinder, gentler way like a sunburn or wind burn. The rash fades in two to five days, often followed by a lacey appearing, faint rash on the body. The rash can be itchy and uncomfortable.

Antihistamines and oatmeal baths may help reduce these symptoms. Acetaminophen (Tylenol) and ibuprofen (Advil or Motrin) help treat fevers and reduce joint pains. As always, lots of fluids help prevent dehydration and fatigue.

Generally this illness is mild and self-limited. However, pregnant women or people who have a compromised immune system should avoid contact with someone suspected to have fifth disease. The infection is contagious for a week before the rash develops but is not contagious once the rash is seen. For that reason, by the time the rash develops, it is not necessary to keep infected children home from school or day care.

So now the burning question: Why is it called fifth disease? It all refers back to those childhood diseases that cause exanthems or rashes. In the early history of medicine, before modern diagnostic tests, it was important to identify what illness a child had. Rashes are an important diagnostic clue so they were used to identify and name illnesses. The first rash-associated illness was named measles. The second was scarlet fever. The third was rubella. The fourth was Duke’s disease, now thought to be a staph infection. If you’re counting, we now have our answer! Running out of names, the fifth rash-associated illness simply became “fifth disease.” It is now also called Erythema Infectiosum, but that just sounds so clinical.

Well, I hope you and your family are well and not suffering from any of our named rashes. If you should have the misfortune of acquiring one of these, your doctor is only a phone call away. Spring is upon us and so is spring break! Have a great one and stay healthy.

Please send me your questions. The only bad question is the unanswered one.

Remember your health is your responsibility. Health is our greatest asset and it doesn’t happen by accident. If something doesn’t seem right, or questions are left unanswered, don’t wait, call your doctor.

Dr. Drew Werner of the Eagle Valley Medical Center writes a weekly column for the Daily. He encourages health questions. Write him by e-mail to editor@vaildaily.com or c/o Editor, Vail Daily, P.O. Box 81, Vail, 81658.


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