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Histopathological and Immunohistochemical Characteristics of Measles Exanthema

A Study of a Series of 13 Adult Cases and Review of the Literature

Liersch, Julia MD*; Omaj, Rizan MD; Schaller, Jörg MD*,†

The American Journal of Dermatopathology: December 2019 - Volume 41 - Issue 12 - p 914–923
doi: 10.1097/DAD.0000000000001431
Original Study

Abstract: Despite available vaccination, measles is one of the leading causes of death among young children in developing countries. In clinical practice, the spectrum of differential diagnoses of morbilliform exanthemas associated with fever is wide, and it can be hard to differentiate from other infectious eruptions, especially in adults or in atypical courses in immunocompromised patients. The goal of our study was to identify characteristic histomorphological and immunohistochemical patterns of measles exanthema through the study of 13 skin biopsy specimens obtained from 13 patients with this disease and a review of cases in the literature. Histopathological features of measles exanthema are quite distinctive and characterized by a combination of multinucleated keratinocytes, and individual and clustered necrotic keratinocytes in the epidermis with pronounced folliculosebaceous as well as acrosyringeal involvement. Immunohistochemical staining of skin biopsies with anti-measles virus (MeV) nucleoprotein and anti-MeV phosphoprotein can be of great value in confirming the diagnosis of measles. Both methods can serve as quick additional diagnostic tools for prompt implementation of quarantine measures and for providing medical assistance, even in patients in whom the clinician did not consider measles as a differential diagnosis of the rash due to the rarity of the disease in a putatively vaccinated community.

*Dermatopathology Duisburg, Duisburg, Germany; and

Department of Dermatology, Allergology and Phlebology, Helios Klinikum Duisburg, Duisburg, Germany.

Correspondence: Jörg Schaller, MD, Dermatopathology Duisburg, An der Abtei 7-11 47166, Duisburg, Germany (e-mail:

The authors declare no conflicts of interest.

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