What is the treatment for 5th disease (erythema infectiosum)?

Treatment of Fifth Disease (Erythema Infectiosum)

Fifth disease (erythema infectiosum) is a self-limiting viral infection that typically requires only supportive care and symptomatic treatment. No specific antiviral therapy is indicated for immunocompetent individuals with this condition.

Clinical Overview

Fifth disease is caused by parvovirus B19 and primarily affects school-aged children. It presents with distinctive clinical features:

• Initial "slapped cheek" appearance on the face
• Followed by lacy, reticular rash on trunk and extremities
• Mild prodromal symptoms may include low-grade fever, headache, and malaise
• Rash typically resolves spontaneously within 1-3 weeks

Treatment Recommendations

For Typical Cases (Immunocompetent Individuals)

• Supportive care only:
  • Rest as needed
  • Adequate hydration
  • Antipyretics for fever (acetaminophen or ibuprofen)
  • NSAIDs for symptomatic relief of discomfort or arthralgia 1

For Joint Pain/Arthralgia (Common in Adults)

• NSAIDs such as ibuprofen or naproxen for 2-12 weeks based on clinical resolution 2
• For recurrent or persistent arthralgia, colchicine may be considered 2

Special Populations

Pregnant Women

• Require close monitoring due to risk of transplacental transmission (30-50%)
• Risk of fetal anemia, hydrops fetalis, or fetal death (3-4% overall, 6-7% if infection before 20 weeks) 3
• Referral to maternal-fetal medicine specialist for:
  • Regular ultrasound examinations
  • Doppler measurements of middle cerebral artery peak velocity
  • Fetal blood sampling if significant anemia is suspected 3

Immunocompromised Patients

• May develop chronic anemia requiring:
  • Red blood cell transfusions
  • Intravenous immunoglobulin in severe cases 1

Patients with Hemolytic Anemia

• At risk for transient aplastic crisis
• May require blood transfusions 1, 4

Differential Diagnosis

Fifth disease should be distinguished from:

• Kawasaki disease
• Scarlet fever
• Measles
• Rubella
• Drug reactions
• Other viral exanthems

Diagnosis

• Primarily clinical based on characteristic "slapped cheek" appearance and lacy rash 5
• Serological testing (IgM and IgG antibodies) can confirm recent infection when diagnosis is uncertain
• PCR testing for parvovirus B19 DNA may be useful in immunocompromised patients or pregnant women 6

Key Points to Remember

• Fifth disease is generally benign and self-limiting in immunocompetent individuals
• No specific antiviral therapy is available or necessary for most patients
• Treatment focuses on symptom management rather than altering the course of infection
• Special attention is required for pregnant women, immunocompromised patients, and those with underlying hemolytic anemia
• The rash may fluctuate in intensity and can recur with exercise, heat exposure, or stress for several weeks

Fifth disease in healthy individuals has an excellent prognosis with complete recovery expected without specific treatment.