Treatment of Fifth Disease Rash
Fifth disease (erythema infectiosum) requires only supportive care, as the rash itself indicates the infection is no longer contagious and treatment is symptomatic only. 1, 2
Key Clinical Context
Fifth disease is caused by human parvovirus B19 and presents with the characteristic "slapped-cheek" facial rash in children 1, 2. By the time the rash appears, the patient is no longer infectious, which is critical for management decisions 1.
Recommended Management Approach
Symptomatic Treatment Only
- No specific antiviral therapy exists or is needed for uncomplicated fifth disease rash 1
- Supportive care is the mainstay of treatment for immunocompetent patients 1
For Pruritus (if present)
- Non-sedating antihistamines such as cetirizine 5-10 mg daily or loratadine 10 mg daily can provide symptomatic relief 3
- Liberal application of emollients to affected areas 3
- Low-potency topical corticosteroids (hydrocortisone 1%) may be applied if significant pruritus occurs 3
Monitoring Requirements
Most patients recover completely without intervention 1. The rash typically resolves spontaneously within 7-10 days 2.
Critical Exceptions Requiring Different Management
High-Risk Populations
Patients with underlying conditions require specialized evaluation rather than simple supportive care 1:
- Hemolytic anemias (sickle cell disease, thalassemia, spherocytosis): Risk of transient aplastic crisis requiring transfusion 1
- Immunocompromised patients: Risk of chronic red cell aplasia requiring intravenous immune globulin therapy 1
- Pregnant women: Risk of fetal hydrops requiring ultrasound surveillance 4
When to Escalate Care
Refer immediately if 1:
- Signs of severe anemia develop (pallor, fatigue, tachycardia)
- Patient is immunocompromised
- Patient is pregnant (requires fetal monitoring)
Common Pitfalls to Avoid
- Do not prescribe antibiotics - this is a viral infection and antibiotics provide no benefit 1
- Do not isolate the patient once rash appears - they are no longer contagious at this stage 1
- Do not perform routine laboratory testing in typical cases with classic presentation 1, 2
- Do not use systemic corticosteroids - these are not indicated for uncomplicated fifth disease 1