|Rash seen in rubella|
An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease.
The term exanthem is from the Greek ἐξάνθημα, exánthēma, 'a breaking out'. It can be contrasted with enanthems which occur inside the body, such as on mucous membranes.
In 1905, the Russian-French physician Léon Cheinisse (1871–1924), proposed a numbered classification of the six most common childhood exanthems.
Of these six "classical" infectious childhood exanthems, four are viral. Numbers were provided in 1905.
The four viral exanthems have much in common, and are often studied together as a class. They are:
|Name||Number||Virus||Rash characteristics |
|Measles (rubeola)||"first disease"||measles virus||Erythematous macules and papules appearing first on the head and spread down over body over 3 days. Enanthem: pathognomonic Koplik spots (punctate blue-white erosions on buccal mucosa)|
|Rubella, ("German measles") identified in 1881.||"third disease"||rubella virus||Pink macules and papules that appear first on the head and spread down over body in 24 hours. Rash disappears in 2-3 days. Enanthem: Forcheimmer sign (punctate petechiae on soft palate or uvula)|
|Erythema infectiosum, identified as a distinct condition in 1896.||"fifth disease"||parvovirus B19||Confluent erythematous and edematous patches on cheeks ("slapped cheek") for 1-4 days followed by a "lacy," reticular, erythematous rash on the body.|
|Roseola infantum (exanthem subitum)||"sixth disease"||HHV-6 and HHV-7||Rapid onset of erythematous, blanching macules and papules surrounded by white halos on the trunk after 3-5 days of high fever. The rash spreads to the neck and body extremities and lasts 1-2 days.|
Scarlet fever, or "second disease", is associated with the bacterium Streptococcus pyogenes. Fourth disease, also known as "Dukes' disease" is a condition whose existence is not widely accepted today. It was described in 1900 and is postulated to be related to the bacterium Staphylococcus aureus.
In 1979 and 2001 a possible "seventh disease" was postulated following reports of a condition in Japan also referred to as acute febrile infantile mucocutaneous lymph node syndrome (MCLS).
Many other common viruses apart from the ones mentioned above can also produce an exanthem as part of their presentation, though they are not considered part of the classic numbered list:
- Varicella zoster virus (chickenpox or shingles)
- rhinovirus (the common cold)
- unilateral laterothoracic exanthem of childhood
- Some types of viral haemorrhagic fever are also known to produce a systemic rash of this kind during the progression of the disease.
- Tick-borne diseases like Rocky Mountain spotted fever produce a rash that may become extensive enough so as to be classified as exanthemous in as many as 90% of children with the disease.
- ^ "Viral exanthems". Primary Care Dermatology Society. Primary Care Dermatology Society. Retrieved 16 December 2022.
- ^ "Roseola Glossary of Terms with Definitions on MedicineNet.com". Archived from the original on 2008-09-14.
- ^ Robert R. Briney. Primary Cutaneous Actinomycosis
- ^ David M. Morens. Fifth Disease: Still Hazy After All These Years
- ^ Dictionary of Virology
- ^ St. Louis Courier of Medicine (1906)
- ^ Principles and Practice of Clinical Virology
- ^ Bialecki C, Feder HM, Grant-Kels JM (November 1989). "The six classic childhood exanthems: a review and update". J Am Acad Dermatol. 21 (5 Pt 1): 891–903. doi:10.1016/s0190-9622(89)70275-9. PMID 2681288.
- ^ "fifth disease" at Dorland's Medical Dictionary[dead link]
- ^ Scott, MD, Lycia A; Stone, MD, Mary Seabury (2003). "Viral exanthems". Dermatology Online Journal. 9 (3): 4. doi:10.5070/D33WD095BT. PMID 12952751.
- ^ a b Weisse ME (January 2001). "The fourth disease, 1900-2000". Lancet. 357 (9252): 299–301. doi:10.1016/S0140-6736(00)03623-0. PMID 11214144. S2CID 35896288.
- ^ Altman, Lawrence K (November 30, 1982). "THE DOCTOR'S WORLD". The New York Times. Retrieved 2009-11-07.
- ^ Patel, Mitesh; Charlton, Rodger (2015-07-27). "First to seventh diseases: discarded diagnoses?". BMJ. 351: h3525. doi:10.1136/bmj.h3525. ISSN 1756-1833. S2CID 71125596.
- ^ https://www.cdc.gov/mmwr/pdf/r/rr5504.pdf[dead link]
- Overview at About.com
- Definition at MedTerms
- Differential diagnosis Archived 2015-09-24 at the Wayback Machine
- Dermatology Quiz Includes photo, diagnosis, and treatment of unilateral laterothoracic exanthem (ULE).