The exanthem consists of erythematous macules and papules beginning at the forehead and behind the ears, eventually spreading in a cephalocaudal fashion down the neck, upper extremities, trunk, and lower extremities. Confluent lesions can occur on the face. The rash typically peaks for three to four days, then begins to fade at day five in the same manner in which it appeared. Desquamation typically occurs after approximately one week. Koplik spots may develop two to three days after symptoms begin and prior to the generalized cutaneous eruption. Look for minute, white papules, which may have a central bluish-white portion, usually opposite the second molars on the buccal mucosa. This enanthem is considered pathognomonic for measles.
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ACEP Now: June 2025 (Digital)(See the original question here.)
Source: Visual Dx
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