Medication Summary

Symptomatic relief of erythema infectiosum may be provided using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve fever, malaise, headache, and arthralgia, along with topical antipruritics and antihistamines (which also relieve pruritus). Treatment also includes 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.

Class Summary

NSAIDs 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)

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This agent has analgesic, anti-inflammatory, and antipyretic properties. It inhibits inflammatory reactions and pain, possibly by decreasing prostaglandin synthesis.

Diclofenac (Voltaren XR, Cataflam, Cambia)

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This is one of a series of phenylacetic acids that has demonstrated anti-inflammatory and analgesic properties in pharmacological studies. It is believed to inhibit the enzyme cyclooxygenase, which is essential in the biosynthesis of prostaglandins. Diclofenac can cause hepatotoxicity; hence, liver enzymes should be monitored in the first 8 weeks of treatment. It is absorbed rapidly; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation. The delayed-release, enteric-coated form is diclofenac sodium, and the immediate-release form is diclofenac potassium.

Piroxicam (Feldene)

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Piroxicam is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

Naproxen (Anaprox, Naprelan, Aleve, Naprosyn)

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Naproxen is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

Flurbiprofen

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Flurbiprofen may inhibit cyclooxygenase, thereby inhibiting prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Indomethacin (Indocin)

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Indomethacin is absorbed rapidly; it is metabolized in the liver via demethylation, deacetylation, and glucuronide conjugation. It is useful in the diagnosis of CH because it helps other headache syndromes (eg, chronic paroxysmal hemicrania).

Class Summary

Antihistamines provide symptomatic relief of pruritus.

Hydroxyzine (Vistaril)

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This agent has antipruritic, anxiolytic, and mild sedative effects. It antagonizes H1 receptors in the periphery and may suppress histamine activity in the subcortical region of the central nervous system (CNS).

Diphenhydramine (Benadryl, Diphenhist, Allerdryl)

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Diphenhydramine is used for the symptomatic relief of pruritus caused by the release of histamine in inflammatory reactions.

Class Summary

These help to relieve the discomfort of itching skin.

Camphor/menthol topical (Icy Hot Arthritis Lotion)

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Camphor/menthol lotion is a cooling, soothing, moisturizing lotion used to help alleviate pruritus.

Class Summary

Immunoglobulin is helpful in chronic aplastic crisis or infected, immunocompromised patients. No evidence indicates that IVIG is beneficial in pregnant women with human parvovirus (PV) B19 infection.

Immunoglobulin, intravenous (Octagam, Privigen, Gammagard S/D)

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IVIG neutralizes circulating myelin antibodies via anti-idiotypic antibodies, down-regulates proinflammatory cytokines (including interferon-gamma), blocks Fc receptors on macrophages, suppresses inducer T and B cells, augments suppressor T cells, blocks complement cascade, promotes remyelination, and increases IgG in cerebrospinal fluid by 10%.

Questions

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Media Gallery

Classic slapped-cheek appearance of fifth disease.
Pathognomonic reticulated, lacy-appearing eruption of fifth disease.

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Author

Glenn L Zellman, MD Consulting Staff, Department of Internal Medicine, University Hospital, Tamarac, Florida

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Megan Boysen, MD Resident Physician, Department of Emergency Medicine, University of California Irvine Medical Center

Megan Boysen, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine