What are the symptoms and treatment options for fifth disease (slapping cheek disease)?

Slapped Cheek Disease (Erythema Infectiosum): Symptoms and Treatment

Slapped cheek disease, also known as erythema infectiosum or fifth disease, is characterized by a distinctive "slapped cheek" facial rash followed by a lacy rash on the trunk and extremities, and is typically a mild, self-limiting illness in children caused by parvovirus B19.

Clinical Presentation

Prodromal Phase

• Initial symptoms are usually mild and consist of low-grade fever, headache, malaise, and myalgia 1
• This phase typically occurs 4-14 days after exposure (incubation period) 1
• Many patients may be asymptomatic during this initial phase 1

Classic Three-Stage Rash

1. First Stage (Facial Rash)

   • Erythematous "slapped cheek" appearance on the face 1
   • Bright red rash on both cheeks with relative circumoral pallor 2
   • This is the most distinctive feature of the disease 3

2. Second Stage (Body Rash)

   • Rash spreads to trunk, extremities, and buttocks as diffuse macular erythema 1
   • Develops a characteristic lacy or reticulated appearance due to central clearing 1
   • More intense on extensor surfaces with palms and soles typically spared 1

3. Third Stage (Fluctuating Rash)

   • Characterized by evanescence and recrudescence 1
   • Rash may fade and reappear with environmental changes (temperature, sunlight, stress) 2
   • Can last up to three weeks before resolving spontaneously without sequelae 1

Differences in Adults

• Rash is less pronounced in adults compared to children 1
• Only about 20% of affected adults have the facial rash 1
• More commonly presents with arthralgia or arthritis, especially in women 4
• Rash more frequently found on legs, trunk, and arms in adults 1

Diagnosis

• Diagnosis is primarily clinical, based on the characteristic rash pattern 1
• Laboratory testing is generally not required for typical cases in children 2
• In uncertain cases, serologic testing for parvovirus B19 IgM and IgG antibodies can confirm recent infection 5

Treatment

• Treatment is symptomatic and supportive as the illness is usually self-limiting 1
• Antipyretics and analgesics may be used for fever and discomfort 2
• No specific antiviral therapy is indicated for uncomplicated cases 3
• Children with fifth disease do not need to be excluded from school or childcare once the rash appears, as they are unlikely to be infectious at this stage 3

Special Considerations

Pregnant Women

• Infection in pregnant women, particularly before 20 weeks gestation, can lead to complications 5
• Vertical transmission occurs in approximately 33% of maternal infections 5
• Fetal complications (hemolysis, anemia, hydrops fetalis) occur in about 3% of infected pregnant women 5
• Pregnant women exposed to parvovirus B19 should be tested for IgM and IgG antibodies 5
• Those with positive IgM (indicating acute infection) require close obstetrical monitoring with serial ultrasounds 5

Patients with Hematologic Disorders

• Patients with hemolytic disorders may develop transient aplastic crisis 4
• Immunocompromised patients may develop chronic anemia 4
• These patients may require more intensive monitoring and supportive care 4

Prognosis

• Excellent prognosis in immunocompetent children 2
• The condition is typically self-limited with complete resolution 2
• Complications are rare in healthy children 1