Measles: Viral infectious disease with symptoms of eyes & skin

Measles is an acute contagious infectious disease caused by a virus. The infection is accompanied by general symptoms such as fever and sore throat, but eye-related problems and a skin rash also occur. The disease rarely appears in Western countries due to vaccination policies, but in developing countries many patients still die every year as a result of measles. The disease, which is easy to diagnose clinically, can be treated supportively. Patients with this disease have a very good prognosis. Nevertheless, serious to life-threatening complications sometimes occur.

  • Epidemiology: Mainly children with infectious disease
  • Synonyms measles
  • Causes: Measles virus
  • Symptoms of eyes (conjunctivitis) and skin (rash)
  • Diagnosis and examinations
  • Treatment of viral infectious disease
  • Prognosis is excellent
  • Complications
  • Prevention disease

Epidemiology: Mainly children with infectious disease

Measles is a highly contagious disease that mainly affects young children worldwide. Thanks to a measles vaccine, the incidence of this infectious disease has fallen dramatically in Western countries. According to the World Health Organization, it is estimated that around 135,000 patients worldwide die each year as a result of a measles infection, mainly in Africa and Southeast Asia. The highest mortality rates occur in children younger than twelve months.

Synonyms measles

The term measles has several synonyms such as:

  • morbilli
  • rubeola

Causes: Measles virus

A virus causes measles. The spread of measles occurs through droplet infection. The infected droplets are released into the air through sneezing or coughing, which someone can then inhale. The measles virus also remains alive for up to two hours after it has become airborne. Contamination also occurs through close personal contact or direct contact with a contaminated nasal or throat secretion. The virus infects the respiratory tract and then spreads to the rest of the body. 90% of people who come into contact with a patient with measles will get the disease unless they are protected (vaccinated). Patients transmit the disease most quickly four days before to four days after the appearance of the rash.

Symptoms of eyes (conjunctivitis) and skin (rash)

The disease presents itself in different phases, initially with general symptoms and eye problems. Subsequently, a characteristic maculopapular rash (skin rash with spots and bumps) occurs.

General symptoms

The incubation period (time between infection and the appearance of symptoms) of measles is 8-14 days. The first general symptoms include:

  • a strawberry tongue (bright red tongue with bumpy papillae)
  • a runny nose (rhinorrhea)
  • a loss of appetite
  • swollen armpits
  • cough
  • high fever
  • a sore throat
  • malaise (a general ill feeling)
  • irritability
  • muscle strain
  • stomatitis (inflammation of the mucous membrane in and around the mouth)
  • fatigue

Red eyes with conjunctivitis / Source: Marco Mayer, Wikimedia Commons (CC BY-SA-4.0)

Eyes Eye-
related problems that appear in conjunction with measles include bloodshot eyes, conjunctivitis (eye conjunctivitis with red eyes and watery eyes), swollen eyelids and hypersensitivity to light (photophobia).

Skin rash

In the early stages of the disease, Koplik spots are already visible in the mouth/cheeks. These are small, blue-gray and irregular spots on the buccal mucosa (enanthema) that appear about two days before the appearance of a rash. Three to five days after the patient develops general symptoms of illness, a rash develops on the forehead. The (slightly) itchy rash quickly spreads to the face, top of the neck and the rest of the body. Within three days, the rash has usually reached the hands (palms) and feet (pads). The skin lesions consist of flat and discolored spots (macules) but also of solid, raised and red spots (papules). The macules and papules then join together later, giving rise to a characteristic “maculopapular rash” (skin rash with spots and bumps) in measles. The rash disappears after about four to seven days and leaves a brown discoloration.

Diagnosis and examinations

Physical and diagnostic examination

A doctor diagnoses most cases of measles simply based on the visible symptoms. He bases this on the classic symptoms: coughing, a runny nose, conjunctivitis, Koplik spots and the rash. If necessary, he will perform a blood or saliva test to confirm the diagnosis.

Differential diagnosis

The clinical picture of the following conditions is approximately similar to that of measles. The doctor therefore considers this as a differential diagnosis:

  • acute conjunctivitis
  • side effects of medication
  • Kawasaki disease (inflamed blood vessels in the arteries)
  • enteroviral infections
  • erythema infectiosum (mild disease with rash and joint pain)
  • toxic shock syndrome (severe bacterial infection with fever and organ damage)
  • skin complications of viral hemorrhagic fever (serious illness with fever and bleeding caused by a virus)
  • glandular fever (viral infection with sore throat, swollen lymph nodes, fatigue and low-grade fever that occurs mainly in adolescents and young adults)
  • dengue fever
  • meningitis (meningitis with headache, fever and stiff neck)
  • parvovirus B19 infection
  • Rocky Mountain spotted fever (tick-borne disease with fever, headache and rash)
  • scarlet fever (bacterial infection with sore throat and rash)
  • roseola infantum (fever and rash in young children)
  • rubella (rubella: rash on the face, trunk, arms and legs)
  • sepsis (blood poisoning)
  • serum sickness (condition with fever, rash and joint pain)
  • syphilis (bacterial infection through sexual contact)
  • systemic lupus erythematosus (autoimmune disorder)

Treatment of viral infectious disease

The treatment of measles is supportive and consists of painkillers, bed rest and humidified air. Closing the curtains is useful for hypersensitivity to light. To reduce eye irritation, it helps to moisten the eyes with cotton wool. Furthermore, a patient with measles stays at home for at least four days from the time the rash first appears. Some children are given vitamin A supplements, which is helpful in reducing the risk of death and complications in children who do not take enough vitamin A. Antibiotics are only indicated if a secondary bacterial infection occurs due to measles.

Prognosis is excellent

The prognosis of patients with the infectious disease without additional complications is excellent. The rash disappears on average after fourteen days after exposure to the virus.


The most feared complication of a child with a weakened immune system is acute encephalitis (inflammation of the brain), with an incidence of 1/1000 to 1/5000 patients. The prognosis is poor, with a high mortality (30%) and serious sequelae in survivors. Measles also has a high mortality rate in patients with malnutrition and patients with other diseases. Complications are common in such patients and include bacterial lung infection (pneumonia), bronchitis (inflammation of the tracheal tubes), middle ear infection (otitis media) and gastrointestinal infection (gastroenteritis). Less commonly, the patient develops inflammation of the heart muscle (myocarditis), inflammation of the liver (hepatitis), and inflammation of the brain and spinal cord (encephalomyelitis). Other complications include blindness, severe diarrhea and dehydration. In malnourished or ill patients, sometimes no rash develops, but widespread peeling of the skin (peeling). Unlike rubella, maternal measles does not cause abnormalities in the fetus. However, a pregnant woman with measles runs a higher risk of miscarriage and premature birth.

Prevention disease

Prevent measles

A previous attack of measles confers a high degree of immunity and a second episode of measles is rare. Children in Western countries are immunized with the combined measles-mumps-rubella (MMR) vaccine, which they receive at the ages of fourteen months and nine years.

Good hand hygiene is necessary / Source: Gentle07, Pixabay

Preventing the spread of measles
The spread of measles can be prevented thanks to a few tips:

  • Wash hands frequently with soap and water.
  • Cover the mouth and nose with a paper tissue when coughing or sneezing, and immediately throw the tissue in the trash after use. If a handkerchief is not available, sneezing into your elbow is the best option (do not cough or sneeze into your hands).
  • Sharing drinks or eating utensils is not recommended.
  • Regularly disinfect frequently touched surfaces, such as toys, doorknobs, tables, counters, etc.

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  • Viral skin infection: Skin infections caused by virus
  • Common infectious skin conditions