Can Fifth Disease Rash Be Itchy?
Yes, the rash associated with erythema infectiosum (fifth disease) can be itchy, occurring in approximately 50% of cases. 1
Clinical Characteristics of Fifth Disease Rash
The rash of erythema infectiosum typically evolves through three distinct stages 1:
- Stage 1: Erythematous "slapped cheek" appearance on the face 1
- Stage 2: Diffuse macular erythema spreading to trunk, extremities, and buttocks with characteristic lacy or reticulated pattern after central clearing 1
- Stage 3: Evanescence and recrudescence (the rash may come and go) 1
Pruritus in Fifth Disease
Pruritus is a recognized feature of parvovirus B19 infection, noted in approximately 50% of adult cases. 1 While the research literature specifically documents this in adults, the symptom can occur in children as well 2. The itching is part of the normal clinical presentation and does not indicate a complication or atypical manifestation.
Important Clinical Distinctions
The reticulated or lacy pattern of the rash helps distinguish fifth disease from other childhood exanthems 1. Key features include:
- Palms and soles are typically spared 1
- The rash is more intense on extensor surfaces 1
- In adults, the rash is less pronounced and often atypical, with only 20% showing facial erythema 1
- The rash usually resolves spontaneously within three weeks without sequelae 1
Management of Pruritus
When pruritus is present with fifth disease:
- Treatment is primarily symptomatic and supportive 1
- Antihistamines may provide symptomatic relief, though only a limited proportion of patients derive benefit 3
- Patients should be advised about possible sedative effects of antihistamines on driving or operating machinery 3
Critical Pitfall to Avoid
Do not confuse fifth disease with more serious conditions that can present with rash and pruritus. While fifth disease is typically benign, other conditions requiring urgent intervention (such as Rocky Mountain Spotted Fever or meningococcemia) can present with rash 4, 5. The distinguishing features of fifth disease—the characteristic "slapped cheek" appearance followed by lacy reticulated pattern, absence of systemic toxicity, and typical resolution within weeks—help differentiate it from life-threatening conditions 1.