What is the treatment for Fifth disease (erythema infectiosum)?

Treatment of Fifth Disease (Erythema Infectiosum)

Fifth disease (erythema infectiosum) requires only symptomatic and supportive treatment as it is typically a self-limiting condition that resolves spontaneously within three weeks without sequelae. 1

Disease Overview

• Fifth disease is a common exanthematous illness of childhood caused by human parvovirus B19 that spreads primarily through respiratory tract secretions 1
• The condition most commonly affects children between 4 and 10 years of age, with an incubation period of 4 to 14 days 1
• The characteristic rash evolves in three stages:
  1. Initial "slapped cheek" appearance on the face
  2. Spread to trunk and extremities with a lacy or reticulated appearance
  3. Evanescence and recrudescence phase 1

Recommended Treatment Approach

Symptomatic Management

• Antipyretics for low-grade fever (acetaminophen or ibuprofen) 1
• Rest and adequate hydration for general malaise and fatigue 1
• Antihistamines may be considered for pruritus, which occurs in approximately 50% of cases 1

Special Considerations

Arthritis/Arthralgia

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain and inflammation, which is more common in adults than children 1, 2

Immunocompromised Patients

• Patients with chronic hemolytic anemias may develop transient aplastic crisis requiring close monitoring and possibly transfusion 1, 2
• Immunocompromised patients may develop chronic anemia requiring specialized care 2

Pregnant Women

• Pregnant women exposed to fifth disease should be evaluated for immune status:
  • If IgG positive (already immune), there is no risk to the fetus
  • If not immune, fetal surveillance with repeated ultrasonographic examinations is recommended due to risk of fetal hydrops, although this risk is very low 3

Important Clinical Pearls

• No specific antiviral treatment exists for parvovirus B19 infection 1
• Antibiotics are not indicated as this is a viral illness 1
• The diagnosis is primarily clinical and laboratory confirmation is usually unnecessary in typical cases 1
• The rash in adults may be less pronounced and often atypical compared to children 1
• Conjunctivitis may occasionally be present and requires only supportive care 4

Complications to Monitor

• Transient aplastic crisis in patients with underlying hemolytic disorders 1, 2
• Arthropathy, particularly in adult women 2
• Fetal hydrops in pregnant women (rare) 3

The self-limiting nature of fifth disease in immunocompetent individuals means that treatment focuses on symptom relief rather than attempting to alter the course of the infection 1, 2.