Measles (Rubeola)

Clinical Hallmark: A highly contagious viral infection characterized by a high fever and the "Three C's": Cough, Coryza (runny nose), and Conjunctivitis.

Ask for vaccination history!

The Rash (Exanthem):

• Morphology: Erythematous maculopapular rash that becomes confluent (merges together).
• Progression: Craniocaudal spread—starts at the hairline and behind the ears, then moves down to the trunk and extremities.
• Duration: Lasts about 6-7 days and fades in the same order it appeared, sometimes leaving "branny" desquamation.

Rubella (German Measles)

• The Clue: Forchheimer spots (petechiae on the soft palate) and significant post-auricular/occipital lymphadenopathy.
• Vs Measles: Rubella rash is much lighter pink, does not become confluent, and the patient is usually much less ill than a measles patient.

Scarlet Fever

• The Clue: "Sandpaper" texture rash and a Strawberry Tongue. Often follows a Streptococcal sore throat.
• Vs Measles: Scarlet fever rash usually spares the face (showing circumoral pallor) and is bacterial (Strep pyogenes), not viral.

🛑 Koplik Spots:

Small, bluish-white spots on an erythematous base found on the buccal mucosa opposite the lower molars. They appear 48 hours before the rash and are diagnostic.

Public Health Action:

Measles is a notifiable disease in Malaysia. Notify the District Health Office (PKD) immediately upon clinical suspicion.

Supportive Therapy:

• Vitamin A Supplementation: All individuals with measles should receive 200,000 IU (or 100,000 IU in infants) of vitamin A for 2 days according to WHO latest key facts.
• Hydration: Encourage oral fluids to prevent dehydration.

Symptomatic Treatment:

• Cetirizine 10mg OD.
  [Child: 0.25mg/kg OD]
• Piriton 4mg ON/TDS.
  [Child: 0.1mg/kg ON/TDS]
• Paracetamol 1g TDS.
  [Child: 0.15mg/kg QID]
• Calamine Lotion

⚠️ Clinical Pearl: Isolation is mandatory. The patient is infectious from 4 days before to 4 days after the onset of the rash.