Treatment for Fifth Disease (Erythema Infectiosum) in Children
Fifth disease in children requires only supportive care with no specific antiviral treatment, as it is a self-limited viral illness caused by parvovirus B19 that resolves spontaneously.
Management Approach
Supportive Care Only
- No specific antiviral therapy exists or is needed for uncomplicated fifth disease in immunocompetent children 1, 2
- The illness is typically mild and self-resolving, requiring only symptomatic management 1
Symptomatic Treatment
- Antipyretics (acetaminophen or ibuprofen) for fever control if present
- Rest and adequate hydration during the acute phase
- Antihistamines may be considered if pruritus accompanies the rash
Clinical Course Expectations
- The characteristic "slapped-cheek" facial rash and lacy reticular rash on trunk and extremities typically resolve without intervention 3, 2
- Most cases are actually subclinical or very mild 4
- The child is no longer contagious once the rash appears 2
Important Caveats and Monitoring
When to Escalate Care
- Children with underlying hemolytic anemias (sickle cell disease, hereditary spherocytosis) require close monitoring for transient aplastic crisis, which may necessitate transfusion 1
- Immunocompromised children may develop chronic anemia and require specialist consultation 1
- Conjunctivitis may occasionally accompany fifth disease and can be managed with supportive care 3
School/Daycare Attendance
- Children may return to school once the rash appears, as they are no longer infectious at this stage 2
- Exclusion from school is not necessary once the exanthem is present
Pregnancy Considerations for Household Contacts
- If the child's mother or other pregnant household contacts are exposed, they should be evaluated for immune status (IgG antibody testing) 5, 4
- Pregnant women who are not immune require fetal surveillance with serial ultrasounds to monitor for hydrops fetalis, though the actual risk is very low 5, 4
What NOT to Do
- Do not prescribe antibiotics, as this is a viral illness 1, 2
- Do not use antiviral medications - they are ineffective against parvovirus B19
- Do not restrict activities beyond what the child's symptoms dictate
- Do not perform routine laboratory testing in otherwise healthy children with typical presentation 2