Haha, usually I'd just take care of it with my medicine team to spare the derm team the consult. I actually think it's also a nice learning experience for the IM team (but I'm probably the only one that thinks that)...

Yes! I’m starting to use it and hoping it’s a game changer

Quibble away! What say you about DRESS treatment! I want to learn!

Based on what I see, patients would be contagious around when fever and other symptoms start, so I think theoretically you could have viral shedding leading to contagiousness prior to those symptoms but it should be around the same time. If others know please chime in!

So to recap:
✅Measles is super contagious
✅rash occurs 4 days after symptom onset, 2 weeks after exposure
✅rash is morbiiliform and spread top down
✅also can see Koplik spots, cough, coryza, conjunctivitis, fever
✅vaccines save lives

Thanks for joining!
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Finally, measles is more common with more serious complications in younger kids (<5), especially the unvaccinated. Patients go on to have otitis media, encephalitis, and can even die from this disease.
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And as someone who sees a LOT of morbilliform eruptions, my personal plan is to remember to look in the mouths of my patients, ask about how the rash spread (top to bottom), and paying particular attention to other symptoms like cough, coryza, and conjunctivitis!
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So what can we do? Well, vaccination has always been the best way to prevent measles. BUT, your immunity can wane after immunization, so that means even in a fully vaccinated individual, we shouldn't forget about measles on the ddx if you see this constellation of symptoms!
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Patients are thought to be contagious from symptom onset to 4 days after the rash (so basically a little over a week surrounding the rash).

The virus is transmitted through respiratory droplets that can linger in the air for hours!
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In patients with darker skin, the redness is less obvious, and just looks like skin colored or darker bumps.
cdc.gov/measles/sign...
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Unlike a drug rash, measles often starts up top and moves down (cephalocaudal), whereas drug rashes start on the chest & move out often.

This also means measles affects the face often, whereas drug rashes can often spare the face.
cdc.gov/measles/sign...
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Then ~4 days after symptoms started, the rash pops up.

The term we use to describe a classic "measles-like" rash is "morbilliform." This means 3-4 mm pink papules that coalesce into plaques. That probably sounds familiar because that's how we describe regular ol' drug rashes!
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Koplik spots are whitish/reddish papules that are commonly in the buccal mucosa, but can also be on the palate itself.

These are thought to be pathognomonic for measles!

PC: onlinelibrary.wiley.com/doi/10.1111/...
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After exposure, measles usually has an ~ 10 day incubation period, and then symptoms start with a fever, and the 3 C's: Cough, Coryza (runny nose), and Conjunctivitis.

2-3 days after symptoms starts, you can also see Koplik spots in the mouth.

This is all BEFORE the rash!
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Measles is caused by a ssRNA virus in the Paramyxoviridae family. It's HIGHLY contagious. It has a higher primary and secondary attack rate than Covid (meaning getting measles after an exposure is easier than Covid). Then transmitting it to close contacts later is ALSO easier!
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