The rash is most prominent in the body creases and may be macular, hemorrhagic vesicles, petechial, or urticarial. Complications may include pneumonia, pleural effusion, hilar lymphadenopathy, hepatosplenomegaly, hyperesthesia, or paresthesia. All persons vaccinated after 1967 have received the live attenuated measles vaccine, which is not associated with atypical measles. The measles rash is a maculopapular erythematous rash that involves the palms and soles. Lesion density is greatest above the shoulders where macular lesions may coalesce.
Laboratory investigation is generally unnecessary, given the classic clinical presentation.
Serology or viral culture can confirm the diagnosis, but this is unnecessary for routine cases. Supportive care is normally all that is required. Occasionally, IV hydration is required, as these patients may be significantly febrile and become very dehydrated. Fever management with standard antipyretics is appropriate. Secondary infections, such as pneumonia and otitis media, should be treated with antibiotics.