Dukes' disease

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Fourth disease
Classification and external resources
Specialty infectious disease
ICD-10 B09
ICD-9-CM 057.8

Dukes' disease, named after Clement Dukes,[1] also known as fourth disease[2] or Filatov-Dukes' disease (after Nil Filatov),[3] is an exanthem. It is distinguished from measles or forms of rubella though it was considered as a form of viral rash.[2] Although Dukes identified it as a separate entity, it is thought not to be different from scarlet fever caused by exotoxin-producing Streptococcus pyogenes after Keith Powell proposed equating it with the condition currently known as Staphylococcal scalded skin syndrome in 1979.[2][4]

It was never associated with a specific pathogen,[5] and the terminology is no longer in use.[2] However, mysterious rash of unknown cause in school children often gives rise to the question whether it can be Dukes' disease.[6]

Signs and symptoms[edit]

Signs and symptoms may include fever, nausea, vomiting, and diarrhea, along with typical viral symptoms of sensitivity to light, enlarged lymph nodes, sore throat, and possibly brain inflammation. The rash may appear at any time during the illness. It is usually generalised. The rash consists of erythematous maculopapules with areas of confluence. They may be urticarial, vesicular, or sometimes petechial. The palms and soles may be involved. The eruptions are more common in children than in adults. Usually, the rash fades without pigmentation or scaling.


  1. ^ Dukes, C (30 June 1900). "On the confusion of two different diseases under the name of rubella (rose-rash)". The Lancet. 156 (4011): 89–95. doi:10.1016/S0140-6736(00)65681-7. 
  2. ^ a b c d Weisse, ME (31 December 2000). "The fourth disease, 1900-2000". The Lancet. 357 (9252): 299–301. doi:10.1016/S0140-6736(00)03623-0. PMID 11214144. 
  3. ^ Dukes-Filatov disease at Who Named It?
  4. ^ Powell, KR (January 1979). "Filatow-Dukes' disease. Epidermolytic toxin-producing staphylococci as the etiologic agent of the fourth childhood exanthem". Am. J. Dis. Child. 133 (1): 88–91. doi:10.1001/archpedi.1979.02130010094020. PMID 367152. 
  5. ^ Morens, DM; Katz, AR (September 1991). "The "fourth disease" of childhood: reevaluation of a nonexistent disease". Am. J. Epidemiol. 134 (6): 628–40. PMID 1951267. 
  6. ^ "Dukes' return? On the trail of the mysterious rash in school children". Healio, Infectious Diseases in Children. April 2002. Retrieved 19 August 2013.