View source for Exanthem

{{Short description|Widespread rash occurring on the body}}
{{Infobox medical condition (new)
| name            = Exanthem
| synonyms        = Exanthema
| image           = Rash of rubella on skin of child's back.JPG
| caption         = Rash seen in [[rubella]]
| field           = [[Dermatology]]
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An '''exanthem''' is a widespread [[rash]] eruption occurring on the outside of the body, usually presents in [[children]], the rash is typically associated with constitutional symptoms including fever and fatigue.<ref name="pcds">{{cite web |title=Viral exanthems |url=https://www.pcds.org.uk/clinical-guidance/viral-exanthems |website=Primary Care Dermatology Society |publisher=Primary Care Dermatology Society |accessdate=16 December 2022 |language=en }}</ref><ref name=":0" /> It is usually caused by a virus,<ref name=":0">{{Cite web |title=Exanthems (reactive rashes) |url=https://dermnetnz.org/topics/exanthems |access-date=2024-05-17 |website=DermNet}}</ref> but an exanthem can be caused by [[bacteria]],<ref name="pmid11214144" /> [[toxin]]s, [[drug]]s, other [[microorganism]]s, or as a result of [[autoimmune disease]].<ref name=":0" /> Exanthems associated with viruses are usually not specific but some are pathognomonic for certain viruses, the rash is not caused by the virus itself but the bodies reaction to the virus.<ref name=":1">{{Cite journal |last=Drago |first=Francesco |last2=Ciccarese |first2=Giulia |last3=Gasparini |first3=Giulia |last4=Cogorno |first4=Ludovica |last5=Javor |first5=Sanja |last6=Toniolo |first6=Antonio |last7=Broccolo |first7=Francesco |date=2017-02-01 |title=Contemporary Infectious Exanthems: An Update |url=https://www.tandfonline.com/doi/epdf/10.2217/fmb-2016-0147?needAccess=true |journal=Future Microbiology |volume=12 |issue=2 |pages=171–193 |doi=10.2217/fmb-2016-0147 |issn=1746-0913 |pmid=27838923|hdl=10281/135791 |hdl-access=free }}</ref>

The term exanthem is from the [[Greek language|Greek]] {{langx|el|ἐξάνθημα|translit=exánthēma|lit=a breaking out|label=none}}.<ref>{{cite web |url=http://www.medicinenet.com/roseola/glossary.htm |title=Roseola Glossary of Terms with Definitions on MedicineNet.com |url-status=dead |archive-url=https://web.archive.org/web/20080914174824/http://www.medicinenet.com/roseola/glossary.htm |archive-date=2008-09-14 }}</ref> It can be contrasted with [[enanthem]]s which occur inside the body, such as on mucous membranes. Exanthems occasionally present in association with enanthems .<ref>{{Cite journal |last=Keighley |first=Caitlin L. |last2=Saunderson |first2=Rebecca B. |last3=Kok |first3=Jen |last4=Dwyer |first4=Dominic E. |date=April 2015 |title=Viral exanthems |url=https://journals.lww.com/co-infectiousdiseases/fulltext/2015/04000/viral_exanthems.5.aspx |journal=Current Opinion in Infectious Diseases |language=en-US |volume=28 |issue=2 |pages=139 |doi=10.1097/QCO.0000000000000145 |issn=0951-7375|url-access=subscription }}</ref>

==Infectious exanthem==
in 1900, the physician Clement Dukes assigned a number for the known exanthems affecting the pediatric age group which are first disease (measles), second disease (scarlet fever), third disease (rubella), and fourth disease (filatove-dukes).<ref>{{Cite web |last=Ninkov |first=Tatiana |last2=Cadogan |first2=Mike |last3=Cadogan |first3=Tatiana Ninkov and Mike |date=2022-08-01 |title=Sixth disease |url=https://litfl.com/sixth-disease/ |access-date=2025-02-18 |website=Life in the Fast Lane • LITFL |language=en-US}}</ref> In 1905, the Russian-French physician Léon Cheinisse added fifth disease which is now known as erythema infectiosum or slapped cheek syndrome.<ref name=":2">{{Cite book |last=Mahy |first=Brian W. J. |url=https://books.google.com/books?id=ksSkuSLzXJsC&pg=PA446 |title=The Dictionary of Virology |date=2009-02-26 |publisher=Academic Press |isbn=978-0-08-092036-8 |language=en}}</ref><ref>{{Cite book |last=Zuckerman |first=Arie J. |url=https://books.google.com/books?id=I6bqb6Z8MC8C&pg=PA710 |title=Principles and Practice of Clinical Virology |last2=Banatvala |first2=Jangu E. |last3=Pattison |first3=John R. |last4=Griffiths |first4=Paul |last5=Schoub |first5=Barry |date=2004-08-13 |publisher=John Wiley & Sons |isbn=978-0-470-02096-8 |language=en}}</ref><ref name="Morens">{{Cite journal |last=Morens |first=David M. |date=1982-08-06 |title=Fifth Disease: Still Hazy After All These Years |url=https://jamanetwork.com/journals/jama/article-abstract/376218 |journal=JAMA |volume=248 |issue=5 |pages=553–554 |doi=10.1001/jama.1982.03330050035026 |issn=0098-7484|url-access=subscription }}</ref> In 1909, sixth disease (roselola infantum or exanthem subitum) was introduced by John Zahorsky.<ref>{{Cite web |last=Ninkov |first=Tatiana |last2=Cadogan |first2=Mike |last3=Cadogan |first3=Tatiana Ninkov and Mike |date=2022-05-09 |title=John Zahorsky |url=https://litfl.com/john-zahorsky/ |access-date=2025-02-18 |website=Life in the Fast Lane • LITFL |language=en-US}}</ref>

Of these six "classical" infectious childhood exanthems,<ref name="pmid2681288">{{cite journal |vauthors=Bialecki C, Feder HM, Grant-Kels JM |title=The six classic childhood exanthems: a review and update |journal=J Am Acad Dermatol |volume=21 |issue=5 Pt 1 |pages=891–903 |date=November 1989 |pmid=2681288 |doi=10.1016/s0190-9622(89)70275-9}}</ref> four are viral. Numbers were provided in 1905.<ref>{{DorlandsDict|nine/000952705|fifth disease}} {{Dead link|date=March 2021}}</ref>

The four viral exanthems have much in common, and are often studied together as a class. They are:

{| class="wikitable"
|-
! Name
! Number
! Virus
! Rash characteristics <ref>{{cite journal |last1=Scott, MD |first1=Lycia A |last2=Stone, MD |first2=Mary Seabury |title=Viral exanthems |journal=Dermatology Online Journal |date=2003 |volume=9 |issue=3 |page=4 |doi=10.5070/D33WD095BT |pmid=12952751 |url=https://escholarship.org/uc/item/3wd095bt|url-access=subscription }}</ref>
|-
| [[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.<ref name="pmid11214144">{{cite journal |author=Weisse ME |title=The fourth disease, 1900-2000 |journal=Lancet |volume=357 |issue=9252 |pages=299–301 |date=January 2001 |pmid=11214144 |doi=10.1016/S0140-6736(00)03623-0 |s2cid=35896288 }}</ref>
| "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.<ref name="urlTHE DOCTORS WORLD - New York Times">{{cite news |url=https://www.nytimes.com/1982/11/30/science/the-doctor-s-world.html |title=THE DOCTOR'S WORLD | last=Altman | first=Lawrence K | newspaper=The New York Times |date=November 30, 1982 | access-date=2009-11-07}}</ref>
| "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]]''. [[Dukes' disease|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]]''.<ref name="pmid11214144"/>

In 1979 and 2001 a possible "seventh disease" was postulated following reports of a condition in Japan also referred to as acute febrile infantile [[Kawasaki disease|mucocutaneous lymph node syndrome]] (MCLS).<ref>{{Cite journal|last1=Patel|first1=Mitesh|last2=Charlton|first2=Rodger|date=2015-07-27|title=First to seventh diseases: discarded diagnoses?|url=http://www.bmj.com/lookup/doi/10.1136/bmj.h3525|journal=BMJ|volume=351 |language=en|pages=h3525|doi=10.1136/bmj.h3525|s2cid=71125596 |issn=1756-1833|url-access=subscription}}</ref>

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]])
* [[Mumps]]
* [[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 disease]]s 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.<ref>https://www.cdc.gov/mmwr/pdf/r/rr5504.pdf {{Dead link|date=February 2022}}</ref>

==See also==
*[[List of cutaneous conditions]]

==References==
{{reflist}}

== External links ==
{{Medical resources
| DiseasesDB     = 25831 
| ICD10          = {{ICD10|A|38||a|30}}, {{ICD10|B|05||b|00}}-{{ICD10|B|09||b|00}} 
| ICD9           = {{ICD9|034}}, {{ICD9|055}}-{{ICD9|057}}, {{ICD9|782.1}} 
| ICDO           = 
| OMIM           = 
| MedlinePlus    = 
| eMedicineSubj  = 
| eMedicineTopic = 
| MeshID         = D005076
}}
*[http://dermatology.about.com/library/bldefexanthem.htm Overview] {{Webarchive|url=https://web.archive.org/web/20050917155222/http://dermatology.about.com/library/bldefexanthem.htm |date=2005-09-17 }} at [[About.com]]
*[http://www.medterms.com/script/main/art.asp?articlekey=6530 Definition at MedTerms] {{Webarchive|url=https://web.archive.org/web/20131217081836/http://www.medterms.com/script/main/art.asp?articlekey=6530 |date=2013-12-17 }}
*[http://www.findarticles.com/p/articles/mi_m3225/is_4_62/ai_65106197 Differential diagnosis] {{Webarchive|url=https://web.archive.org/web/20150924053207/http://www.findarticles.com/p/articles/mi_m3225/is_4_62/ai_65106197 |date=2015-09-24 }}
*[https://web.archive.org/web/20060502100610/http://www.childsdoc.org/spring97/quiz/derm.asp Dermatology Quiz] Includes photo, diagnosis, and treatment of unilateral laterothoracic exanthem (ULE).

{{Numbered Diseases of Childhood}}
{{Diseases of the skin and appendages by morphology}}
{{Exanthema}}

[[Category:Dermatologic terminology]]