| Exanthem | |
|---|---|
| Other names | Exanthema |
 | |
| Rash seen in rubella | |
| Specialty | Dermatology |
An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children. [1] 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'. [2] 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. [3] [4] [5] [6] [7]
Of these six "classical" infectious childhood exanthems, [8] four are viral. Numbers were provided in 1905. [9]
The four viral exanthems have much in common, and are often studied together as a class. They are:
| Name | Number | Virus | Rash characteristics [10] |
|---|---|---|---|
| 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. [11] | "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. [12] | "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 . [11]
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). [13]
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:
Bornholm disease, also known as epidemic pleurodynia, is a condition characterized by myositis of the abdomen or chest caused by the Coxsackie B virus or other viruses. The myositis manifests as an intermittent stabbing pain in the musculature that is seen primarily in children and young adults.
Scarlet fever, also known as scarlatina, is an infectious disease caused by Streptococcus pyogenes, a Group A streptococcus (GAS). It most commonly affects children between five and 15 years of age. The signs and symptoms include a sore throat, fever, headache, swollen lymph nodes, and a characteristic rash. The face is flushed and the rash is red and blanching. It typically feels like sandpaper and the tongue may be red and bumpy. The rash occurs as a result of capillary damage by exotoxins produced by S.pyogenes. On darker-pigmented skin the rash may be hard to discern.
Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of enteroviruses. It typically begins with a fever and feeling generally unwell. This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin. Signs and symptoms normally appear 3–6 days after exposure to the virus. The rash generally resolves on its own in about a week. Fingernail and toenail loss may occur a few weeks later, but they will regrow with time.
Roseola, also known as sixth disease, is an infectious disease caused by certain types of human herpes viruses. Most infections occur before the age of three. Symptoms vary from absent to the classic presentation of a fever of rapid onset followed by a rash. The fever generally lasts for three to five days, while the rash is generally pink and lasts for less than three days. Complications may include febrile seizures, with serious complications being rare.
Erythema infectiosum, fifth disease, or slapped cheek syndrome is one of several possible manifestations of infection by parvovirus B19. Fifth disease typically presents as a rash and is more common in children. While parvovirus B19 can affect humans of all ages, only two out of ten individuals will present with physical symptoms.
Human parvovirus B19, generally referred to as B19 virus(B19V),parvovirus B19 or sometimes erythrovirus B19, is the first known human virus in the family Parvoviridae, genus Erythroparvovirus; it measures only 23–26 nm in diameter. Human parvovirus b19 is a below-species classification of Erythroparvovirus primate1. The name is derived from Latin parvum, meaning small, reflecting the fact that B19 ranks among the smallest DNA viruses. B19 virus is most known for causing disease in the pediatric population; however, it can also affect adults. It is the classic cause of the childhood rash called fifth disease or erythema infectiosum, or "slapped cheek syndrome". The name comes from it being the fifth in a list of historical classifications of common skin rash illnesses in children.
Nocardiosis is an infectious disease affecting either the lungs or the whole body. It is due to infection by a bacterium of the genus Nocardia, most commonly Nocardia asteroides or Nocardia brasiliensis.
Pityriasis rosea is a type of skin rash. Classically, it begins with a single red and slightly scaly area known as a "herald patch". This is then followed, days to weeks later, by an eruption of many smaller scaly spots; pinkish with a red edge in people with light skin and greyish in darker skin. About 20% of cases show atypical deviations from this pattern. It usually lasts less than three months and goes away without treatment. Sometimes malaise or a fever may occur before the start of the rash or itchiness, but often there are few other symptoms.
Cutaneous T-cell lymphoma (CTCL) is a class of non-Hodgkin lymphoma, which is a type of cancer of the immune system. Unlike most non-Hodgkin lymphomas, CTCL is caused by a mutation of T cells. The cancerous T cells in the body initially migrate to the skin, causing various lesions to appear. These lesions change shape as the disease progresses, typically beginning as what appears to be a rash which can be very itchy and eventually forming plaques and tumors before spreading to other parts of the body.
Bwamba orthobunyavirus (BWAV) belongs to the genus Orthobunyavirus and the order Bunyavirales RNA viruses. BWAV is present in large parts of Africa, endemic in Mozambique, Tanzania and Uganda. It is transmitted to humans through mosquito bites and results in a brief benign generalised infection with headache, skin rash, diarrhea and joint pain and lasts 4–5 days. The animal reservoir of the virus includes birds, monkeys and donkeys.
Fever of unknown origin (FUO) refers to a condition in which the patient has an elevated temperature (fever) but, despite investigations by one or more qualified physicians, no explanation is found.
Herpes gladiatorum is one of the most infectious of herpes-caused diseases, and is transmissible by skin-to-skin contact. The disease was first described in the 1960s in the New England Journal of Medicine. It is caused by contagious infection with human herpes simplex virus type 1 (HSV-1), which more commonly causes oral herpes. Another strain, HSV-2 usually causes genital herpes, although the strains are very similar and either can cause herpes in any location.
Chickenpox, or chicken pox, also known as varicella, is a highly contagious, vaccine-preventable disease caused by the initial infection with varicella zoster virus (VZV), a member of the herpesvirus family. The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face. It then spreads to the rest of the body. The rash and other symptoms, such as fever, tiredness, and headaches, usually last five to seven days. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is usually more severe in adults than in children.
Gianotti–Crosti syndrome, also known as infantile papular acrodermatitis, papular acrodermatitis of childhood, and papulovesicular acrolocated syndrome, is a reaction of the skin to a viral infection. Hepatitis B virus and Epstein–Barr virus are the most frequently reported pathogens. Other viruses implicated are hepatitis A virus, hepatitis C virus, cytomegalovirus, coxsackievirus, adenovirus, enterovirus, rotavirus, rubella virus, HIV, and parainfluenza virus.
Blueberry muffin baby, also known as extramedullary hematopoiesis, describes a newborn baby with multiple purpura, associated with several non-cancerous and cancerous conditions in which extra blood is produced in the skin. The bumps range from one to seven mm, do not blanch and have a tendency to occur on the head, neck and trunk. They often fade by three to six weeks after birth, leaving brownish marks. When due to a cancer, the bumps tend to be fewer, firmer and larger.
A cold sore is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.
Ticks are insects known for attaching to and sucking blood from land-dwelling animals. Ticks fall under the category of 'arthropod', and while they are often thought of in the context of disease transmission, they are also known to cause direct harm to hosts through bites, toxin release, and infestation. Infestation can cause symptoms ranging from mild to severe and may even cause death. Hosts can include any number of vertebrates, though humans and livestock are more likely to be the interest of researchers.
Asymmetric periflexural exanthem of childhood (APEC) is a rare, self-limited and spontaneously resolving skin rash of the exanthem type with unknown cause that occurs in children. It occurs primarily in the late winter and early spring, most common in Europe, and affecting girls more often than boys. It is probably viral, but no virus has yet been associated with the condition.
Cutaneous manifestations of COVID-19 are characteristic signs or symptoms of the Coronavirus disease 2019 that occur in the skin. The American Academy of Dermatology reports that skin lesions such as morbilliform, pernio, urticaria, macular erythema, vesicular purpura, papulosquamous purpura and retiform purpura are seen in people with COVID-19. Pernio-like lesions were more common in mild disease while retiform purpura was seen only in critically ill patients. The major dermatologic patterns identified in individuals with COVID-19 are urticarial rash, confluent erythematous/morbilliform rash, papulovesicular exanthem, chilbain-like acral pattern, livedo reticularis and purpuric "vasculitic" pattern. Chilblains and Multisystem inflammatory syndrome in children are also cutaneous manifestations of COVID-19.