What are the most dangerous skin rashes. How to identify life-threatening rashes. When should you seek immediate medical attention for a rash. What are the symptoms of severe skin conditions. How are life-threatening rashes treated.

Rocky Mountain Spotted Fever: A Potentially Fatal Tick-Borne Illness

Rocky Mountain Spotted Fever (RMSF) is a serious bacterial infection transmitted by ticks. Despite its name, cases have been reported across the United States, with the highest concentration in south-central and southeastern regions. The disease can affect anyone who spends time outdoors, particularly in wooded areas where ticks thrive.

Transmission and Risk Factors

RMSF is primarily spread through the bite of infected ticks, including:

• Dermacentor variabilis (American dog tick) in the eastern United States
• D. andersoni (Rocky Mountain wood tick) in the western United States

The disease is most common during spring and summer when ticks are most active.

Symptoms and Progression

RMSF typically progresses in two stages:

1. Initial stage (approximately 4 days):
   • Fever
   • Malaise
   • Myalgia
   • Severe headaches
2. Rash stage (starting around day 4, lasting up to 2 weeks):
   • Small pink or red macules appearing on ankles and wrists
   • Rash spreading to the trunk
   • Evolution into petechiae and purpura
   • Possible development of gangrenous areas on extremities and genitals

Is involvement of the scrotum or vulva significant in diagnosing RMSF? Yes, the presence of rash on these areas can be a crucial diagnostic clue for healthcare providers.

Treatment and Prognosis

Early diagnosis and prompt antibiotic treatment are critical for RMSF. The mortality rate ranges from 5% to 25%, emphasizing the importance of timely medical intervention. Delayed diagnosis and treatment can lead to fatal outcomes.

Meningococcal Disease: A Rapidly Progressing Bacterial Infection

Meningococcal disease is caused by the bacteria Neisseria meningitidis and can quickly become life-threatening if not treated promptly. This condition often affects younger individuals and is more prevalent during winter and spring months.

Transmission and Risk Factors

Meningococcal disease spreads through respiratory droplets in close contact situations, such as:

• Military barracks
• College dormitories
• Crowded living conditions

Interestingly, 10% to 20% of healthy people may carry the bacteria without developing symptoms.

Identifying the Meningococcal Rash

The meningococcal rash is a critical early warning sign of the disease. It typically appears as:

• Red or purple discolored spots
• Non-blanching under pressure (purpura)
• Caused by bleeding underneath the skin due to infection

Why is early recognition of the meningococcal rash crucial? The rapid progression of the disease makes immediate identification and treatment essential for improving outcomes and reducing the risk of severe complications.

Treatment Approach

Prompt antibiotic therapy is the cornerstone of meningococcal disease treatment. Any suspicion of this condition warrants immediate medical attention to initiate appropriate interventions and prevent potentially life-threatening complications.

Staphylococcal Toxic Shock Syndrome: Beyond Menstrual Association

Staphylococcal Toxic Shock Syndrome (TSS) is a severe condition caused by toxins released during an overgrowth of Staphylococcus aureus bacteria. While initially associated with menstruation and tampon use, non-menstrual cases are now more common and can affect individuals of any age and gender.

Causes and Risk Factors

Non-menstrual causes of TSS include:

• Influenza
• Childbirth complications
• Tracheitis
• Surgical wound infections
• Nasal packing
• Use of barrier contraceptives

How has the mortality rate of TSS changed over time? The mortality rate for menstrual-related cases has decreased to less than 5%, but non-menstrual cases still carry a two to three times higher risk of death.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Severe Cutaneous Adverse Reactions

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse reactions that can be life-threatening. These conditions are characterized by widespread skin detachment and mucosal involvement.

Causes and Triggers

SJS and TEN are often triggered by:

• Medications (e.g., antibiotics, anticonvulsants, NSAIDs)
• Infections (e.g., Mycoplasma pneumoniae)
• Genetic factors

Symptoms and Progression

The progression of SJS/TEN typically follows this pattern:

1. Prodromal phase: Fever, malaise, and flu-like symptoms
2. Acute phase:
   • Painful, red or purplish rash
   • Blistering and skin detachment
   • Mucosal involvement (eyes, mouth, genitals)
3. Recovery phase: Skin re-epithelialization

What distinguishes SJS from TEN? The extent of skin detachment: SJS involves less than 10% of body surface area, while TEN affects more than 30%. Cases with 10-30% involvement are classified as SJS/TEN overlap.

Treatment and Management

Management of SJS/TEN requires:

• Immediate discontinuation of the suspected triggering agent
• Supportive care in a specialized burn unit or intensive care setting
• Fluid and electrolyte management
• Wound care and infection prevention
• Ophthalmic care to prevent ocular complications

The use of systemic corticosteroids and immunomodulatory therapies remains controversial and varies based on individual cases.

Purpura Fulminans: A Rare but Devastating Skin Emergency

Purpura fulminans is a rare, life-threatening condition characterized by rapid progression of purpuric lesions and skin necrosis. It is often associated with disseminated intravascular coagulation (DIC) and can lead to multi-organ failure if not promptly recognized and treated.

Etiology and Risk Factors

Purpura fulminans can occur in three main contexts:

• Neonatal purpura fulminans: Associated with inherited protein C or S deficiency
• Acute infectious purpura fulminans: Typically seen in severe sepsis, often meningococcal
• Idiopathic purpura fulminans: Rare, with unclear etiology

Clinical Presentation

The hallmark features of purpura fulminans include:

• Rapidly progressing, painful purpuric lesions
• Skin necrosis and ecchymosis
• Hemorrhagic bullae formation
• Peripheral gangrene in severe cases

Why is early recognition of purpura fulminans crucial? The rapid progression of this condition can lead to extensive tissue damage, limb loss, and death if not addressed promptly. Early intervention is key to improving outcomes.

Management and Treatment

Treatment of purpura fulminans involves:

• Aggressive resuscitation and hemodynamic support
• Broad-spectrum antibiotics for infectious causes
• Correction of coagulation abnormalities
• Protein C replacement in cases of deficiency
• Surgical debridement and wound care
• Consideration of amputation in cases of irreversible tissue damage

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

DRESS syndrome is a severe, potentially life-threatening drug reaction characterized by widespread rash, fever, lymphadenopathy, and internal organ involvement. It typically occurs 2-8 weeks after starting the offending medication.

Causative Agents

Common medications associated with DRESS syndrome include:

• Anticonvulsants (e.g., carbamazepine, phenytoin)
• Allopurinol
• Sulfonamide antibiotics
• Antiviral drugs (e.g., abacavir)

Clinical Features

DRESS syndrome typically presents with:

• Extensive maculopapular rash, often progressing to exfoliative dermatitis
• Fever
• Facial edema
• Lymphadenopathy
• Internal organ involvement (liver, kidneys, lungs, heart)
• Hematologic abnormalities, including eosinophilia

How does DRESS syndrome differ from other drug reactions? The delayed onset, prolonged course, and potential for organ involvement distinguish DRESS from more common drug reactions. Its systemic nature makes it particularly dangerous.

Management and Prognosis

Treatment of DRESS syndrome involves:

• Immediate discontinuation of the suspected causative drug
• Supportive care and monitoring of organ function
• Systemic corticosteroids in severe cases
• Long-term follow-up due to the risk of relapse and late-onset autoimmune sequelae

The mortality rate of DRESS syndrome ranges from 5-10%, emphasizing the importance of prompt recognition and management.

Acute Generalized Exanthematous Pustulosis (AGEP): A Severe Pustular Reaction

Acute Generalized Exanthematous Pustulosis (AGEP) is a rare, severe cutaneous adverse reaction characterized by the rapid development of numerous sterile, non-follicular pustules on an erythematous base. While typically drug-induced, it can occasionally be triggered by viral infections.

Etiologic Factors

Common triggers of AGEP include:

• Antibiotics (especially beta-lactams and macrolides)
• Antifungal agents
• Calcium channel blockers
• Antimalarials
• Viral infections (less common)

Clinical Presentation

The hallmark features of AGEP include:

• Sudden onset of fever (>38°C)
• Widespread erythema covered with numerous small, non-follicular pustules
• Edema of the face and hands
• Mucosal involvement (less common than in SJS/TEN)
• Neutrophilia and mild eosinophilia

What distinguishes AGEP from pustular psoriasis? The acute onset, rapid resolution upon drug withdrawal, and absence of personal or family history of psoriasis are key differentiating factors. Additionally, AGEP typically resolves within 1-2 weeks, unlike the chronic nature of pustular psoriasis.

Management and Prognosis

Treatment of AGEP primarily involves:

• Prompt discontinuation of the causative agent
• Supportive care, including fluid and electrolyte management
• Topical corticosteroids for symptomatic relief
• Systemic corticosteroids in severe cases (controversial)

While AGEP generally has a favorable prognosis with a mortality rate below 5%, elderly patients and those with comorbidities may be at higher risk for complications.

Recognizing and promptly addressing these life-threatening rashes is crucial for improving patient outcomes. Healthcare providers and individuals alike should be aware of these conditions’ early warning signs to ensure timely intervention and appropriate management. When in doubt, seeking immediate medical attention for any rapidly progressing or concerning rash is always the safest course of action.

Life Threatening Skin Rashes –

Life Threatening Skin Rashes

Wondering if a rash could be life-threatening? You wouldn’t be wrong to do so! Although most rashes are just bothersome and can be treated over the counter, there are some that are dangerous. The rash itself is not going to kill you, but it is often a sign of a serious disease or illness. 

We have found four rashes in particular that are associated with high morbidity rates and mortality. These life threatening skin rashes come in many forms but they all have one thing in common. They need a timely diagnosis and treatment which can only be achieved by looking for the signs early. If you notice something that looks like these skin diseases then speak to our dermatologists for an immediate answer. 

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Rocky Mountain Spotted Fever 

The first of the life threatening skin rashes on our list.

How it Transmits

This disease is commonly spread through ticks. Ticks are responsible for transmitting many diseases a prime example being lyme disease. There are 2 ticks that cause lyme disease: the Dermacentor variabilis (American dog tick) in the eastern United States or D. andersoni (Rocky Mountain wood tick) in the western United States. 

This disease first appeared in Idaho and Montana, hence the name. However, most cases are concentrated in the south central and southeastern United States. The disease has been reported in almost every state so the name is a little deceiving. Wherever you are, if you’re frequently visiting wooded areas (where ticks are most common) then you are at risk. 

Who it Affects

Since this is transmitted via ticks it can affect just about anybody. It is usually a seasonal disease and most cases occur in the spring and summer when ticks are most active. If you spend time outdoors then its worth checking for these.  

The mortality rate ranges from 5% – 25% (1) so this is not a disease to take chances with. 

What The Rash Looks Like

Stage 1 usually lasts for around 4 days. You may notice: 

• Fever
• Malaise
• Myalgia 
• Sever Headaches 

Stage 2 is typically when the rashes appear. They usually start on day 4 and will last anywhere up to a couple of weeks. Starting on the ankles and wrists, the rashes will spread to involve the trunk of the body. 

Initially, the rash will consist of small pink or red macules that go white with pressure. Over time, the rash evolves into petechia and purpura (pimple and pus spots). Gangrenous areas may even develop on the fingers, toes, nose, ears, scrotum, or vulva. Involvement of the scrotum or vulva is a diagnostic clue.

Treatment 

Prognosis depends heavily on recognising the disease early and treating with antibiotics (2). If the diagnosis comes too late this could prove to be fatal.  

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Meningococcal Disease 

How it Transmits

This disease is caused by a form of bacteria known as Neisseria meningitidis. Interestingly, 10% to 20% of healthy people carry this organism but it usually spreads in close conditions such as in the military or college dormitories. The transmission occurs through respiratory droplets at close proximity. 

Who It Affects

This usually affects younger people, those younger than 20 years of age are the highest risk. The disease is also most common in the winter and spring. 

What The Rash Looks Like

This life threatening rash usually manifests itself on the skin very early on. Since this disease develops rapidly, checking your rash early is important. The disease will typically appear as red or purple discolored spots that do not fade upon applying pressure, also called purpura. The spots are caused by bleeding underneath the skin from the infection.

Treatment 

As with many of these diseases, early treatment is absolutely vital. Antibiotics are typically the best course of treatment but we suggest getting your rash checked immediately. 

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Staphylococcal Toxic Shock Syndrome

How it Transmits 

Another bacteria induced disease: Toxic Shock Syndrome. The body releases toxins after an overgrowth of a bacteria known as Staphylococcus aureus. It was originally associated with menstruation and tampon use. However, nonmenstrual cases have occurred among both sexes and are currently more common (3). 

Nonmenstrual causes include:

• Influenza
• Childbirth
• Tracheitis 
• Surgical wound infections 
• Nasal packing
• Barrier contraceptives 

Who it Affects

This disease can affect  people for various reasons and at any age. Since non-menstrual cases are now the most common we suggest monitoring anyone who could be high risk according to the causes above.

The mortality rate has decreased to less than 5% in menstrual-related cases but is two to three times higher in non-menstrual cases.

What The Rash Looks Like

Apart from the usual fever and malaise symptoms, these life threatening rashes appear on the skin very distinctly. The rash includes:  

• A sunburn like diffuse macular erythroderma 
• Followed by peeling, especially of the hands and feet – within 5 to 14 days 
• Conjunctival injection (bloodshot, red eyes)
• A strawberry tongue 
• Less frequent manifestations are water swelling of the hands and feet, petechiae (red and purple dots on skin), and in time, loss of nails and hair 

Treatment 

Treatment involves identification and removal of the source of S. aureus. Then a course of antibiotics with appropriate supportive care. There are various other treatments but all will require the help of a professional. We suggest getting checked for that suspicious rash and using us a way to fast-track yourself to an appointment.

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Streptococcal Toxic Shock Syndrome

Last but certainly not least on our list of life threatening skin rashes. This rash may sound similar to the last one but is arguably one of the most deadly… 

How It Transmits

This is another form of toxic shock syndrome. However, this diseases is connected to a different bacteria. Known as Streptococcus pyogenes- “the flesh-eating bacteria”. It usually transmits via soft tissue infections such as Cellulitis. This bacteria will look for any way in and usually uses one of the following as its chance to infect you: 

• Burns on skin 
• Laceration
• Surgical incision 
• Decubitus ulcer
• Childbirth trauma 
• Varicella lesion

Who It Affects

The age range of most patients is 20 to 50 years. The absence of protective immunity is thought to be a risk factor for this age-group. The mortality rate ranges from 30 to 70%.

What the Rash Looks Like

The pain is typically localized to an extremity and is often disproportionate to the findings on examination. A thorough examination of the skin will often detect subtle evidence of a soft tissue infection such as:

• Localized swelling
• Tenderness
• Erythema 
• Violaceous bullae that may be seen in necrotizing fasciiti
• Desquamating erythroderma may be present but is less common than in staphylococcal toxic shock syndrome.

Treatment 

Once again this rash and disease needs to be treated swiftly. Once the diagnosis is confirmed, definitive treatment consists of both penicillin G and clindamycin. The latter suppresses bacterial toxin synthesis and inhibits protein synthesis. Aggressive supportive care is necessary for anyone with this disease (4)

We hope these diseases have peaked your interest in how rashes can play a vital role in getting help. You should look at rashes as your body trying to send you a message. Do not ignore it! Especially if you can find a connection between yourself and the causes outlined above. Remember that, despite long waiting times in the US, you can still speak to our online dermatologists within hours. 

Try our FREE dermatology search engine and get peace of mind within a second.

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Toxic Epidermal Necrolysis | Johns Hopkins Medicine

Toxic Epidermal Necrolysis | Johns Hopkins Medicine

What is toxic epidermal necrolysis?

Toxic epidermal necrolysis is a life-threatening skin disorder characterized by a blistering and peeling of the skin. This disorder can be caused by a drug reaction—often antibiotics or anticonvulsives.

What are the symptoms of toxic epidermal necrolysis?

Toxic epidermal necrolysis causes the skin to peel in sheets. This leaves large, raw areas exposed. The loss of skin allows fluids and salts to ooze from the raw, damaged areas. These areas can easily become infected. The following are the other most common symptoms of toxic epidermal necrolysis. However, each individual may experience symptoms differently. Symptoms may include:

• A painful, red area that spreads quickly

• The skin may peel without blistering

• Raw areas of skin

• Discomfort

• Fever

• Condition spread to eyes, mouth/throat, and genitals/urethra/anus 

The symptoms of toxic epidermal necrolysis may resemble other skin conditions. This is a life-threatening condition. Talk with your healthcare provider for a diagnosis if you are suspicious. 

Treatment for toxic epidermal necrolysis

Specific treatment for toxic epidermal necrolysis will be discussed with you by your healthcare provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

The disease progresses fast, usually within 3 days. Treatment usually includes hospitalization, often in the burn unit. If a medicine is causing the skin reaction, it is discontinued. Treatment may include:

• Hospitalization

• Isolation to prevent infection

• Ointments and protective bandages

• Intravenous (IV) fluid and electrolytes

• Antibiotics

• Intravenous immunoglobulin G

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what it is, what it looks like, causes, symptoms and treatment

Measles: description of the disease

Measles is an infectious disease that is transmitted from person to person through the air and often leads to complications. Manifested by a rash, inflammation of the upper respiratory tract, cough, high fever and weakness. The contagiousness of measles is almost 100%, which means that a person without immunity will definitely get sick upon contact with the virus.

Although the disease has been known to mankind for more than 2,000 years, it was first described in detail in the 9th century by the Persian physician Rhazes. In his work, he outlined the main differences between measles and smallpox, two dangerous infections, which at that time were considered as one disease. Rhazes’ recommendations for the treatment of measles and smallpox were used in Europe and Asia until the 17th century.

Rhazes (Abu al-Razi, 865-925 AD) is the first physician in history to describe the symptoms of measles and smallpox based on a clinical examination. Author: Fae

At the beginning of the 20th century, scientists determined that the cause of measles was a virus. But a specific pathogen could only be found half a century later – in 1954. The active fight against measles all over the world began after a vaccine was developed in 1963. As a result, morbidity and mortality from measles have been sharply reduced.

Prior to mass vaccination, two to three major measles epidemics broke out each year worldwide, during which 2–2.5 million people died.

Measles has two names in English-speaking countries: measles (from Latin misellus, “unfortunate”) and rubeola (from Latin rubeolus, “reddish”). Rubella, another viral infection with similar symptoms, is called rubella in English. This often leads to confusion, especially when translating medical articles from English.

In the International Classification of Diseases, Revision 10 (ICD-10), measles is coded B05.

Measles agent

Measles is an infectious disease caused by a virus from the paramyxovirus family (Paramyxoviridae). The genetic material of the pathogen is protected by a protein shell and a double lipid membrane with spikes on the surface. Spikes are specialized proteins that help the virus enter target cells.

Spiked measles virus: H-protein (burgundy) binds pathogen to target cells, F-protein (grey) promotes virus entry into cells

Measles is rapidly killed by exposure to heat, sunlight and disinfectant solutions. Heating up to 60 degrees kills it instantly. In a dried state at 20 degrees, the virus can persist for up to a year.

How measles is transmitted

Measles is most often spread by airborne droplets. When talking, coughing or sneezing with droplets of saliva, a sick person releases viruses – they remain in the air for up to 2 hours.

Other people can become infected by breathing contaminated air. The measles virus is very volatile: with an upward airflow, it is able to enter other rooms through elevator shafts or ventilation systems. That is why, at a time when there were no infectious boxes (isolated wards) in hospitals, the upper floors were allocated for patients with measles.

The measles virus can also enter the body through contact: through the hands, if a healthy person touches objects that contain the virus, and then touches the nose, mouth or eyes.

Susceptibility to measles in non-sick and unvaccinated people is about 95%.

An infected person becomes a source of infection even before the first symptoms appear – until he suspects that he is dangerous to others. Therefore, the sick person freely visits public places, and everyone who does not have immunity against measles becomes a target for the virus.

Measles mechanism

The portal of entry for the measles virus is the mucous membranes of the upper respiratory tract and eyes. The virus attaches to the target cell with the help of a special spike – the H-protein (hemagglutinin), then another spike comes into play – the F-protein, which helps the measles pathogen merge with the cell membrane and penetrate into it. This process is somewhat similar to boarding – a favorite method of capturing ships among medieval pirates.

Inside the infected cell, the virus unpacks the genetic material (RNA) and starts replication – the production of multiple copies of itself. Newly formed viral particles leave the cell and spread throughout the tissues of the body within a few days.

After some time, measles viruses enter the peripheral lymph nodes, and then into the blood. With the bloodstream, pathogens spread throughout the body – just at this time, the patient develops a rash and other symptoms.

Measles prevalence

In many countries in Africa and Asia, measles still occupies a leading position among infectious diseases. This is due to the fact that a significant part of people are not vaccinated.

In Europe and America, the epidemiological situation is better, however, according to the World Health Organization (WHO), the likelihood of outbreaks has increased since 2020: due to the COVID-19 pandemic, measles prevention has shifted to the background. More than 22 million infants did not receive their first dose of the measles vaccine in 2020, and 25 million in 2021. This is a record high and a significant setback in global progress in the fight against a dangerous infection.

In 2021, 9 million cases of measles were registered in the world, 128 thousand patients died.

Measles is dangerous to the health and life of people of all ages. But children from 1 to 5 years old are most at risk of getting sick due to the peculiarities of the work of immunity that has not yet formed.

But babies up to 3 months old can be protected from measles: they receive specific anti-measles antibodies from the mother if she is vaccinated or has been ill before. By the 6th–10th month of life, the number of antibodies decreases and children become susceptible to the virus. If a woman does not have anti-measles antibodies in her blood during pregnancy, then the child can get sick from the first days of life.

Another risk group is people over 20 years old. Even if they were vaccinated in childhood, then over the years, the intensity of immunity decreases until the complete disappearance of protection.

In temperate regions, the incidence of measles increases in late winter and early spring, in the tropics the greatest activity is in the dry season.

Measles classification

According to the type of course, measles is typical and atypical, according to the severity of symptoms – mild, moderate and severe. Depending on how the body copes with the infection, a smooth course of the disease and a complicated one are possible.

Typical measles: symptoms and stages

Measles, like all infections, has a certain sequence of development: incubation period, onset and peak of the disease, recovery.

The incubation period is the time from the moment the virus enters the body until the first symptoms appear. With measles, this period is 9-17 days.

The initial period (catarrhal, prodromal) is the time when mostly general symptoms appear and it is difficult to distinguish measles from other acute respiratory viral infections (ARVI). It usually lasts 3-4 days.

General symptoms of the catarrhal period of measles:

• temperature 38–39 °C;
• runny nose;
• rough dry cough;
• nausea;
• redness of the mucous membrane of the eyes – conjunctivitis;
• intoxication – weakness, chills, headache, loss of appetite.

In the initial period of measles, in addition to general symptoms, specific ones appear. When seeking medical help early, they help the doctor to quickly establish the correct diagnosis. These symptoms include measles enanthema and Belsky-Filatov-Koplik spots.

Measles enanthema – irregular pinkish-red spots 3-5 mm in size that appear on the mucous membrane of the soft and hard palate on the 2nd-3rd day of the disease. After 1-2 days, the spots merge – they can no longer be distinguished against the background of general redness.

Measles enanthema (spotted tonsillitis) on the mucous membrane of the soft palate in a patient with measles on the third day of illness

Belsky – Filatov – Koplik spots – whitish dots on the mucous membrane of the cheeks and near the molars, less often on the lips or gums. They resemble grains of sand 1–2 mm in size, surrounded by a red rim. Such spots are formed due to fine desquamation of epithelial cells of the mucous membranes, do not merge with each other, are not removed and persist for 2-3 days.

Belsky-Filatov-Koplik spots on the buccal mucosa indicate the onset of measles

The height of the disease (catarrhal period) is the period of the appearance of a profuse rash (exanthema). On the 3rd-4th day, it appears behind the ears, on the back of the nose and along the hairline, passes to the face, neck, then from top to bottom: on the torso, arms, and last but not least, on the legs. The palms and soles are usually kept clean.

Typical appearance of a patient with measles during rash: puffy face, difficult nasal breathing, dry lips, watery eyes

Scattered measles rash elements soon merge into large foci

Bright pink rash elements appear against the background of unchanged skin and often merge with each other (maculopapular rash). The more abundant the rash, the more severe the patient’s condition with measles.

Usually, at the end of the catarrhal period, the patient’s temperature drops to subfebrile figures (37–37.5 ° C), and the state of health improves. When rashes appear, the temperature again reaches 39–40 ° C, and the symptoms of intoxication intensify.

A person infected with measles can transmit the virus to other people 4 days before the onset of the first symptoms and up to the 4th day of the rash.

Convalescence is a period of pigmentation that begins on the 3-4th day after the onset of the rash and lasts 1-2 weeks. The rashes darken, then turn copper brown and begin to disappear in the same order as they appeared. The disappearance of the elements of the rash is accompanied by fine peeling and mild itching. There are no marks left on the body.

At this time, the general condition of the patient also improves: the temperature normalizes, the cough decreases. Immunity after an infection, as a rule, persists throughout life.

Cases of measles recurrence are very rare, mainly associated with the appearance of a serious defect in immunity against the background of HIV infection, tumor pathology, or treatment with immunosuppressants.

Features of the course of atypical measles

The classic (typical) course of measles occurs in most cases, but sometimes measles can occur with features.

Asymptomatic . There are no clinical manifestations, the fact of infection can only be detected by laboratory examination.

Erased form . It resembles SARS with a mild course – weak catarrhal manifestations (runny nose, cough) and unexpressed intoxication. There are no rashes with this form of measles.

Mitigated form (from Latin mitis – “light”) . The incubation period can be extended up to 21 days, but at the same time, all the others are shortened: catarrhal, the period of rashes and pigmentation. The symptoms of measles in this form are mild, the temperature is low, the staging of rashes is disturbed, recovery occurs in 2-3 days.

Abortive form (from Latin abortus – “interruption”) . It typically develops up to the 1st or 2nd day of the rash, after which the symptoms disappear abruptly. The patient’s well-being improves, new elements of the rash do not appear – the rashes have time to affect the face and upper body.

Hemorrhagic form . It is distinguished by multiple hemorrhages in the skin and internal organs and a general serious condition. May lead to death.

Hypertoxic form . It proceeds with a pronounced intoxication syndrome against the background of a very high body temperature (40 ° C and above). The patient needs immediate hospitalization.

Complications of measles

Measles is not always benign. Children under 5 years of age and adults over 20 years of age have a high risk of developing complications that may occur due to the spread of viruses through the body or the addition of a bacterial infection.

Common complications of measles:

• croupous laryngitis – inflammation and swelling of the larynx with narrowing of its lumen;
• bronchitis – inflammation of the bronchial mucosa;
• pneumonia – inflammation of the lungs;
• otitis – inflammation of the ear;
• stomatitis – inflammation of the oral mucosa;
• enterocolitis – inflammation of the small and large intestines;
• meningitis – inflammation of the meninges;
• encephalitis – inflammation of the substance of the brain;
• Acute disseminated encephalomyelitis is an autoimmune disease of the brain and spinal cord.

All these complications are united by the fact that they develop either at the height of the disease, or in the coming days or weeks after recovery, when the body weakened by the disease is attacked by a secondary infection or autoimmune complications occur.

The most severe complications of measles are damage to the respiratory and central nervous systems

However, there is one delayed complication of measles that can occur 5 to 10 years after infection, subacute sclerosing panencephalitis (SSPE).

This formidable disease develops due to the fact that the measles virus, after recovery, does not completely disappear from the body, but is partially preserved and acquires the ability to hide from immunity (persistence of the virus).

Years later, the pathogen reactivates and damages the structures of the central nervous system (CNS). Slow neuroinfection occurs more often in people who contract measles before the age of 2 years.

Clinical manifestations of SSPE begin with behavioral changes (irritability, aggression, slovenliness) and end with motor and cognitive disorders. The most significant of them: impaired speech, writing, memorization of information, convulsions, changes in gait, involuntary movements. Sclerosing panencephalitis leads to complete disintegration of the personality, coma and death of the patient.

Sequelae of measles in pregnancy

Measles in pregnant women is more severe than in other adults, and the risk of complications is even higher. The level of immunity decreases during pregnancy, which makes women more vulnerable to any infections.

Measles increases the risk of miscarriage. If a woman is sick with measles in the early stages of pregnancy, when the vital organs and systems of the unborn child are being laid, there is a high probability of fetal malformations.
In the later stages, the risk of giving birth to a child prematurely and with congenital measles infection, which is difficult to treat and can lead to the death of a newborn, most often increases.

Measles diagnostics

Measles infection is suspected if a person has a high fever, catarrhal symptoms, and a rash. Especially if there was contact with someone with measles or with someone who had similar symptoms. Patients being tested for measles are isolated.

General clinical blood and urine tests, as well as a biochemical blood test, help the doctor determine the severity of the infection and the risk of complications.

Clinical blood test with leukocyte formula and ESR (with microscopy of a blood smear when pathological changes are detected) (venous blood)

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Urinalysis

240 ₽

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Biochemistry 8 parameters

1 160 ₽

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Biochemistry 13 indicators

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Biochemistry 21 indicators (extended)

3 690 ₽

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A blood test for specific IgM antibodies to measles in the acute period of the disease helps to confirm the diagnosis.

Measles IgM (n/col)

The study allows to determine the content of class M antibodies (IgM) to the measles virus and to diagnose the acute stage of infection.

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In the first 4 days of illness, antibodies may not be detected – this leads to false negative results if the examination is scheduled early.

Measles can be confirmed by detecting viral RNA in oropharyngeal, nasal swabs, urine or blood before IgM antibodies are detected. To do this, use the method of high-precision diagnostics – PCR test. The viral genome (RNA) can be detected within about 3 days after the onset of the rash.

IgG antibodies to the measles virus are a sign of successful vaccination or a past illness, after which immunity to infection has formed.

Measles IgG (col.)

The study allows you to detect antibodies to the measles virus and determine their content in the blood in order to diagnose a current or past infection, to assess immunity to measles after vaccination.

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Treatment of measles

There is no specific treatment for measles. The doctor prescribes symptomatic therapy depending on the symptoms, the severity of the disease and the likely complications.

Groups of drugs that a doctor can prescribe for a typical course of measles:

• antipyretics – for fever above 38 °C;
• vitamin A – with measles, vitamin A reserves are depleted, which leads to a decrease in resistance to the disease and secondary infections;
• antitussives – for dry obsessive cough;
• mucolytics and expectorants – when a wet cough appears to facilitate the removal of sputum;
• nasal vasoconstrictor – for a short time with a runny nose and nasal congestion.

The causative agent of the disease is a virus, so antibacterial drugs are ineffective for measles. The doctor can prescribe antibiotics only in case of development of secondary bacterial complications or for their prevention.

Measles prophylaxis

The main thing in the prevention of measles is to prevent the spread of a highly contagious disease and the onset of an epidemic. For this, early diagnosis is used and the sick are isolated until the 5th day from the moment the rash appears.

Adults who did not have measles and were not vaccinated as children can receive 2 doses of the vaccine at least 3 months apart

The only effective individual protection against measles is vaccination. The first vaccination is given to children at 12 months, the second – at 6 years. According to studies, after the first vaccine, immunity is formed in 69-81% of cases, after the second – in 95% and lasts a maximum of 18 years.

10 years after vaccination, only a third of those vaccinated have protective antibodies in their blood.

You can check the strength of immunity using a blood test for IgG antibodies to the measles virus. If the level of anti-measles antibodies is low, the protection against the virus has weakened and it is time to revaccinate. Adults are advised to have their IgG levels checked for measles every 5 years.

Measles IgG (col.)

The study allows you to detect antibodies to the measles virus and determine their content in the blood in order to diagnose a current or past infection, to assess immunity to measles after vaccination.

55 bonuses to the account

550 ₽

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People who for some reason did not have a routine vaccination and were in the focus of infection are given emergency vaccination in the first 72 hours from the moment of contact with a measles patient.

Unvaccinated pregnant women and children who have not reached vaccination age (less than 6 months) are injected with measles immunoglobulin to prevent the spread of infection – it already contains antibodies to the virus.

After the introduction of immunoglobulin, passive immunity is formed and the likelihood of getting measles in the near future decreases. If a person does become infected, then the disease proceeds in a mild form, and the likelihood of complications is minimal.

Sources

1. Measles in children: clinical guidelines / Ministry of Health of the Russian Federation. 2015.
2. Kondamudi N. P., Waymack J. R. Measles / StatPearls. 2022.
3. Krawiec C., Hinson J. W. Rubeola (Measles) / StatPearls. 2023.
4. Litusov N. V. Paramyxoviruses (parainfluenza, mumps and measles viruses). Illustrated tutorial. Yekaterinburg, 2018.
5. Belyaeva N.M., Tryakina I.P., Sinikin V.A., Nikitina G.Yu. Kor: textbook. M., 2015.

dermatologists warn about the inadmissibility of self-diagnosis

Any, even the most innocent rash can be a harbinger of a serious illness, say the doctors of the dermatovenerological dispensary. For example, at least 600 patients are diagnosed with psoriasis every year in the region. And then there are fungal infections, warts and other “charms”. However, with age and experience, we all become our own doctors: the temperature has risen – this is the flu. Breaks the lower back – sciatica. Redness and itching appeared – there is no doubt an allergy. The sofa and the TV help us to establish ourselves in our rightness, and even suggest the “best” ways of treatment. However, this approach can be dangerous for humans. Why you should not self-medicate and what symptoms should convince us to urgently see a doctor? These questions were answered by specialists from the Regional Clinical Dermatovenerologic Dispensary for Primorskaya Gazeta.

Beware of psoriasis
The number of patients with this chronic skin disease is constantly growing. The causes of the disease are not fully understood. Some doctors believe that the disease occurs due to the low stress resistance of the population, while others associate it with the deteriorating environment.
According to Irina Ovchinnikova, head of the psoriasis center at the Regional Clinical Dermatovenerological Dispensary, the center registers about 600 new patients with psoriasis every year. In total, about three thousand patients with this diagnosis are registered in the dispensary. Approximately the same number of cases was recorded along the edge.

– Often patients complain of an allergy to deodorant, but in fact this is a manifestation of psoriasis, which can occur in the armpits, in the groin, on the scalp – anywhere. It looks like a rash on the skin in the form of plaques of bright red color, covered with silver-gray scales. Its patients may be confused with fungal infections. But if you turn to specialists in time, then psoriasis is diagnosed quite simply, – explains Irina Ovchinnikova.

Psoriasis is an autoimmune disease, if it first appeared, you need to understand that it cannot be cured, but with proper treatment, you can achieve long-term remissions and avoid exacerbations.
— It is important to start treatment on time, — explains the head of the psoriasis center. “Thanks to modern methods, we control this disease, there is modern physiotherapy and balneotherapy in Chistovodny. For patients who are not suitable for traditional methods, we prescribe genetically engineered therapy.

By the way

Psoriasis affects not only the skin, but also the nail plates and joints. It is psoriasis of the nails that the patient can confuse with a fungal infection. The patient is self-medicating, using antifungal drugs, and he needs a completely different therapy.

Fight against warts
Warts are not as harmless as they seem. It’s a disease, and it’s contagious. At risk are visitors to saunas and pools. It must be remembered that in such places you should not walk barefoot. And besides, it is necessary to wash your feet after visiting such places and walking along the street in open shoes.

Doctors warn that any wart is a reason to see a doctor. They must either be removed or treated.
– There are plantar warts that appear on the feet and grow as if inside the skin. They become inflamed, hurt so much that it hurts a person to walk. – Tells and. O. head of the mycological center Natalya Khrapkova. – Warts need to be treated and removed. We remove them with nitrogen and prescribe an external antiviral treatment.

All-season misfortunes
The Mycological Center of the Regional Clinical Dermatovenerological Dispensary primarily deals with contagious skin diseases, mainly of fungal etiology. This is a well-known microsporia – in the people ringworm, which is transmitted from sick cats and dogs.

By the way

Basically, infection with microsporia occurs in the summer-autumn period, when children spend a lot of time on the street and communicate uncontrollably with animals. The peak incidence occurs in June, when street cats bring kittens en masse, the peak of diagnosis is early September, when medical examinations take place before kindergarten and school.

Another disease that awaits us regardless of the season is scabies. And you can get it in the most unexpected places. For example, a sick person tried on some thing in the store, and then you put it on – there is a chance of getting infected. The solution is to follow the rules of hygiene and wash your hands first. Especially after shopping, swimming pool, transport. Water and soap are the main protection. Recall that the season of contagious skin diseases is the end of spring and summer.

From love to sickness
Doctors warn: venereal diseases, unlike any other, have no seasonality. The main problem is that these diseases are asymptomatic for a long time.

– There are no complaints, no clinical manifestations – this is the main tendency of most infections, when a person is not bothered by anything, – says dermatovenereologist Veronika Ulzutueva. – We have such an attitude to life that everyone thinks: “This will not affect me.” Young people have casual sex, unprotected sex, and then it turns out that some kind of infection has appeared. This causes shock and surprise. And the fact that a person has changed partners for five years and has never been protected is in the order of things.

The age of those infected with syphilis is from 18 to 70 years. According to Veronika Ulzutueva, there are frequent cases when the disease is detected in the later stages – 5, 10, 15 years have passed from the moment of infection. The main route of transmission of syphilis is sexual, but household is also possible: through dishes, bedding, hygiene items.

By the way

In 2018, 268 cases of syphilis infection were detected. This is a first time diagnosis. Every year the number of cases is growing, although the disease is easily diagnosed by doing a blood test. But part of the population does not go to polyclinics for years.

What should a person pay attention to in order not to grow a disease for 10-15 years, but go to the hospital?
– If there are discharges or rashes on the mucous membranes, on the body, on the genitals, you need to go to the doctor, – Veronika Ulzutueva insists. – And if syphilis is not treated, internal organs are damaged: the heart, joints, organs of vision, and the nervous system.