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The earliest symptoms of measles (rubeola) are:
- High fever, rising over three days to 39°C or 40°C
- Runny nose
- A harsh, dry cough
- Red, inflamed eyes (conjunctivitis) and aversion to bright light
Once these symptoms start, small white spots with a red base can be seen on careful examination of the inside of the mouth, usually opposite the molar teeth on the inside of the cheeks. These are known as Koplik’s spots (see picture below).
These spots are unique to measles and can help an experienced health professional to confirm the diagnosis. However, the spots can easily be missed since they appear and disappear in the space of less than a day.
The symptoms listed above rapidly become increasingly severe and are at their worst once the rash appears.
The rash of measles usually appears 3-5 days after the symptoms start. A red or reddish-brown rash that’s slightly raised to the touch usually first appears on the forehead. The rash spreads to the rest of the face and, typically, appears behind the ears and neck. Within 24 hours the entire face, upper arms and chest become involved.
Over the next 24 hours, the rash spreads over the back, stomach and thighs, eventually reaching the feet by the third day. As the rash progresses, the individual spots typically tend to merge into one another (see picture below).
Once the rash reaches the feet, there’s usually a rather sudden improvement, including a drop in temperature. If the temperature doesn’t fall at this time, a complication should be suspected. The rash will start to fade and turn brownish, followed by some peeling.
It’s useful to note that, although the process isn’t visible, the rash is occurring internally as well, involving the respiratory tract and the gut. This explains the typical measles hacking cough, the common complications of croup and measles pneumonia, and also the diarrhoea that may occur.
Reviewed by Prof Eugene Weinberg, Paediatrician at the University of Cape Town’s Allergy and Immunology Unit. April 2018.
