Dermatological manifestations of measles infection in hospitalised paediatric patients observed in the 2009 - 2011 Western Cape epidemic

Introduction. Measles is an acute vaccine-preventable infection common in childhood. In this study, the common dermatological signs of measles were designated the ‘classic dermatological measles syndrome’. Methods. We attempted to ascertain the prevalence of ‘non-classic’ dermatological measles presentation in 69 paediatric patients admitted to New Somerset Hospital, Western Cape, during the recent South African measles outbreak. The patients were examined and photographed, after informed consent had been obtained, and findings were assessed by 1 dermatology consultant and 6 dermatology registrars. Measles infection was confirmed in 38 of the patients by means of IgM testing. The data were analysed using Stata version 11.1 statistical software. Outcomes. Of the group, 17.4% (95% confidence interval (CI) 8.2 - 26.6%) displayed a ‘classic’ measles dermatological picture, although all had been clinically diagnosed and admitted as complicated measles cases. Of those serologically confirmed to have measles (N=38), 26.3% (95% CI 11.6 - 40.9%) conformed to the ‘classic’ dermatological picture. Therefore, a significant majority of these patients presented with what was considered in this study to be a ‘non-classic’ dermatological picture.Conclusions. Measles infection in a paediatric population requiring admission may frequently present without a full-house ‘classic’ dermatological picture. Recognised signs in isolation may be of greater value than the classically described syndrome as a whole. ‘Non-classic’ dermatological forms may occur more frequently than anticipated in complicated cases needing admission. Skin necrosis may be associated with measles. S Afr Med J 2012;102(6):356-359