Treatment of Fifth Disease (Slapped Cheek Disease) in Children
Fifth disease in children requires only supportive care with rest, fluids, and antipyretics for fever, as the infection is self-limited and children are no longer contagious once the characteristic rash appears. 1, 2
Clinical Recognition and Natural History
Fifth disease, caused by parvovirus B19, presents with a distinctive three-stage rash pattern in children aged 4-10 years 1:
- Stage 1: Bright erythematous "slapped cheek" appearance on the face 1, 2
- Stage 2: Lacy, reticulated rash spreading to trunk, extremities, and buttocks (sparing palms and soles) 1
- Stage 3: Evanescence and recrudescence of the rash over approximately three weeks 1
The incubation period is typically 4-14 days, with mild prodromal symptoms including low-grade fever, headache, malaise, and myalgia 1. Critically, by the time the characteristic rash appears, the child is no longer infectious and does not require isolation from school or childcare 2, 3.
Treatment Approach
No specific antiviral therapy exists or is needed for uncomplicated fifth disease in immunocompetent children 2:
- Provide symptomatic relief with antipyretics for fever 2
- Ensure adequate hydration 2
- Reassure parents that the rash resolves spontaneously within three weeks without sequelae 1
- Pruritus, present in approximately 50% of cases, can be managed with antihistamines if bothersome 1
When Laboratory Confirmation Is Needed
Clinical diagnosis based on the characteristic "slapped cheek" rash is sufficient in most cases and does not require laboratory confirmation 2. However, serum immunoglobulin M testing should be obtained if 2:
- The diagnosis is uncertain
- The patient is immunocompromised
- The patient has underlying hemolytic anemia (sickle cell disease, thalassemia, spherocytosis)
- Exposure occurred in a pregnant contact requiring risk assessment
Critical Complications to Monitor
While most children recover completely with supportive care alone, certain high-risk populations require closer monitoring 2:
- Patients with shortened erythrocyte lifespan (sickle cell disease, thalassemia, iron deficiency anemia) are at risk for transient aplastic crisis and may require transfusion support 2
- Immunocompromised children may develop chronic red cell aplasia requiring intravenous immune globulin therapy 2
Important Pitfall to Avoid
Do not exclude children from school or childcare once the rash appears, as they are no longer contagious at this stage 2, 3. The infectious period occurs during the prodromal phase before the rash develops, when the illness is indistinguishable from a common cold 2. Unnecessary exclusion causes unwarranted disruption to families without providing any public health benefit 3.
Pregnant Contact Considerations
If a pregnant woman under 20 weeks gestation has been exposed to a child with fifth disease, she requires serum antibody screening 3, 4. Approximately 40% of childbearing-age women remain nonimmune and susceptible to infection 4. Maternal infection can lead to fetal hydrops or miscarriage in 8-17% of cases, though 50% of exposed fetuses remain unaffected 3, 4. Any pregnant contact with positive immunoglobulin M requires specialist referral for serial ultrasound surveillance 3, 4.