Duke's disease

Dukes' disease or fourth disease is a viral rash most commonly caused by enteroviruses, Echoviruses, and members of the coxsackievirus family.

Some of these eruptions are characteristic of the causative virus, but in most cases one must be satisfied with the diagnosis of viral rash. Signs and symptoms may include fever, nausea, vomiting, and diarrhea, along with typical viral symptoms of photophobia, lymphadenopathy, sore throat, and possibly encephalitis. 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.

The terms "fourth disease" and "Dukes' disease" are rarely used today.