Dukes' disease

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Fourth disease
Other names: Filatov-Dukes' disease

Dukes' disease is a historic name of a mysterious infectious rash.[1]

It was named after Clement Dukes,[2] also known as fourth disease[3] or Filatov-Dukes' disease (after Nil Filatov),[4] is an exanthem. It is distinguished from measles or forms of rubella, though it was considered as a form of viral rash.[3] 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.[3][5]

It was never associated with a specific pathogen,[6] and the terminology is no longer in use.[3] However, a mysterious rash of unknown cause in school children often gives rise to the question of whether it could be Dukes' disease.[7]

Signs and symptoms

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.[citation needed]


Nil Filatov (in 1895) and Clement Dukes (in 1894) described an exanthematous disease which they thought was a form of rubella, but in 1900, Dukes described it as a separate illness which came to be known as Dukes' disease,[2] Filatov's disease, or fourth disease. However, in 1979, Keith Powell identified it as in fact the same illness as the form of scarlet fever which is caused by staphylococcal exotoxin and is known as staphylococcal scalded skin syndrome.[3][8][9]


  1. Paller, Amy S.; Mancini, Anthony J. (2022). "16. Exanthemous diseases of childhood". Paller and Mancini - Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. St. Louis, Missouri: Elsevier. p. 452. ISBN 978-0-323-54988-2. Archived from the original on 2022-12-19. Retrieved 2022-12-19.
  2. 2.0 2.1 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.
  3. 3.0 3.1 3.2 3.3 3.4 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. S2CID 35896288.
  4. Dukes-Filatov disease at Who Named It?
  5. 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.
  6. Morens, DM; Katz, AR (September 1991). "The "fourth disease" of childhood: reevaluation of a nonexistent disease". Am. J. Epidemiol. 134 (6): 628–40. doi:10.1093/oxfordjournals.aje.a116135. PMID 1951267.
  7. "Dukes' return? On the trail of the mysterious rash in school children". Healio, Infectious Diseases in Children. April 2002. Archived from the original on 24 September 2015. Retrieved 19 August 2013.
  8. Melish, ME; Glasgow, LA (June 1971). "Staphylococcal scalded skin syndrome: the expanded clinical syndrome". The Journal of Pediatrics. 78 (6): 958–67. doi:10.1016/S0022-3476(71)80425-0. PMID 4252715. Archived from the original on 13 December 2019. Retrieved 19 August 2013.
  9. Morens, David M; Katz, Alan R; Melish, Marian E (31 May 2001). "The fourth disease, 1900–1881, RIP". The Lancet. 357 (9273): 2059. doi:10.1016/S0140-6736(00)05151-5. PMID 11441870. S2CID 35925579. Archived from the original on 26 January 2020. Retrieved 27 June 2019.

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