eMedicine Specialties > Dermatology > Viral Infections

Erythema Infectiosum (Fifth Disease): Treatment & Medication

Author: Glenn L Zellman, MD, Consulting Staff, Department of Internal Medicine, University Hospital, Tamarac, Florida
Contributor Information and Disclosures

Updated: Dec 8, 2009

Treatment

Medical Care

Because erythema infectiosum (fifth disease) most often is a benign self-limited disease, reassuring the parents often is the only intervention necessary.12 For patients with arthralgias or pruritus, symptomatic relief can be obtained using oral analgesics and antihistamines or topical antipruritic lotions.

Consultations

  • Dermatologist: Refer patients for diagnosis and dermatologic care.
  • Internal medicine specialist: Refer patients for associated conditions.
  • Obstetrician/gynecologist: Due to potential complications from intrauterine parvovirus B-19 (PV-B19) infection, refer pregnant women who have IgM antibodies to PV-B19 or who have been exposed to the virus. Maternal alpha-fetoprotein levels and serial ultrasounds followed through the pregnancy may help predict complications.

Activity

Activities may be pursued as tolerated, with sun protection or avoidance.

Medication

Symptomatic relief of erythema infectiosum (fifth disease) may be provided using nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and topical antipruritics, along with plenty of fluids and rest. For an acute aplastic crisis, supplemental oxygen and blood transfusions may be necessary. Intravenous immunoglobulin (IVIG) is helpful for chronic anemia in patients who are immunocompromised.

Nonsteroidal anti-inflammatory drugs

Provide relief for fever, malaise, headache, and arthralgia. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen usually is the drug of choice (DOC) for initial therapy. Other options include fenoprofen, flurbiprofen, mefenamic acid, ketoprofen, indomethacin, and piroxicam.


Ibuprofen (Ibuprin, Advil, Motrin)

Has analgesic, anti-inflammatory, and antipyretic properties. Inhibits inflammatory reactions and pain, possibly by decreasing prostaglandin synthesis.

Adult

200-400 mg PO tid/qid

Pediatric

5-10 mg/kg PO tid/qid (100 mg/5 mL susp)

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; peptic ulcer disease; recent GI tract bleeding or perforation; renal insufficiency; patients at high risk for bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

FDA category D (unsafe in pregnancy) in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy

Antihistamines

Provide symptomatic relief of pruritus.


Hydroxyzine (Atarax, Vistaril)

Antihistamine with antipruritic, anxiolytic, and mild sedative effects. Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS.

Adult

25-50 mg PO tid/qid prn for pruritus

Pediatric

2-3 mg/kg/d PO divided tid/qid prn for pruritus (10 mg/5 mL syr)

CNS depression may increase with alcohol or other CNS depressants

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Associated with clinical exacerbations of porphyria (may not be safe for patients with porphyria); ECG abnormalities (alterations in T waves) may occur; may cause drowsiness; caution patients regarding operating automobiles and other dangerous machinery because of possible sedation; anticholinergic effects (eg, dry mouth) may occur

Topical antipruritics

Help relieve the discomfort of itching skin.


0.5% camphor/0.5% menthol lotion

Cooling, soothing, moisturizing lotion used to help alleviate pruritus.

Adult

Apply topically to affected areas bid/tid prn for pruritus

Pediatric

<2 years: Not recommended
>2 years: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For topical use only; avoid contact with eyes; discontinue if irritation occurs

More on Erythema Infectiosum (Fifth Disease)

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Treatment & Medication: Erythema Infectiosum (Fifth Disease)
Follow-up: Erythema Infectiosum (Fifth Disease)
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References
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Further Reading

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Keywords

erythema infectiosum, fifth disease, slapped-cheek disease, academy rash, Sticker's disease, Sticker disease, childhood exanthem, Parvovirus B19, PV-B19, PV-B19 infection, Parvoviridae family, acute arthropathy, acute polyarthropathy, coryza, pharyngitis, arthralgias, malar rash

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Contributor Information and Disclosures

Author

Glenn L Zellman, MD, Consulting Staff, Department of Internal Medicine, University Hospital, Tamarac, Florida
Disclosure: Nothing to disclose.

Medical Editor

Bernice R Krafchik, MBChB, FRCPC, Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto
Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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