Spotting the Signs: A Scoping Review of Pediatric Measles Rash Patterns in an Era of Variable Vaccination (2012–2024)
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Keywords
pediatric, measles, rash
Abstract
Background Although measles was declared nearly eliminated in the United States, recent years have seen a resurgence linked to vaccine hesitancy and declining herd immunity. Many clinicians lack firsthand experience diagnosing measles, and atypical presentations complicate recognition. Consolidated descriptions of the evolving clinical spectrum in the vaccine-hesitant era remain limited.
Objective: To characterize the range of clinical presentations of pediatric measles in the context of vaccination status, immune history, and access to care.
Methods We conducted a retrospective synthesis of 10 pediatric case reports and series published between 2012 and 2024, identified through targeted PubMed and Google Scholar searches. Inclusion criteria emphasized pediatric populations and documentation of rash morphology. Data extracted included symptomatology, vaccination history, diagnostic accuracy, and time to diagnosis.
Results Among the cases reviewed, 80% exhibited the classic cephalocaudal rash progression, while several demonstrated atypical patterns, such as sparing of extremities or back-to-front distribution. Atypical presentations were more frequent in partially vaccinated or immunocompromised patients. Koplik spots were inconsistently reported. Diagnostic delays were common due to overlap with other pediatric conditions and low clinical suspicion, particularly among older children and adolescents.
Conclusions The clinical presentation of measles in pediatric patients is increasingly variable in the vaccine-hesitant era, contributing to delayed recognition. Awareness of atypical rash distributions and inconsistent presence of pathognomonic findings is essential for timely diagnosis and outbreak control.
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