What are the physical findings characteristic of exanthem in measles?

Updated: Jun 06, 2019
  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Answer

Blanching, erythematous macules and papules begin on the face at the hairline, on the sides of the neck, and behind the ears (see the images below). Within 48 hours, they coalesce into patches and plaques that spread cephalocaudally to the trunk and extremities, including the palms and soles, while beginning to regress cephalocaudally, starting from the head and neck. Lesion density is greatest above the shoulders, where macular lesions may coalesce. The eruption may also be petechial or ecchymotic in nature.

Face of boy with measles. Face of boy with measles.
Morbilliform rash. Morbilliform rash.

Patients appear most ill during the first or second day of the rash. The exanthem lasts for 5-7 days before fading into coppery brown hyperpigmented patches, which then desquamate. The rash may be absent in patients with underlying deficiencies in cellular immunity.


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