Morphology Severe cutaneous reaction following measles immunization Arun C. Inamadar, MD, DVD, Shailaja S. Patil, MD, and Aparna Palit, MD From the Departments of Dermatology, Venereology, and Leprosy, and Community Medicine, BLDEA’s SBMP Medical College, Hospital and Research Center, Bijapur, Karnataka, India Correspondence Arun C. Inamadar, MD, DVD Department of Dermatology, Venereology, and Leprosy BLDEA’s SBMP Medical College, Hospital and Research Center Bijapur-586103, Karnataka India E-mail: aruninamadar@rediffmail.com Case Measles is an acute, febrile, viral exanthema of childhood associated with high morbidity and grave sequelae. Live measles vaccines are routinely administered to all infants as a prophylactic measure. We describe a child with severe local cutaneous reactions following measles vaccination, probably resulting from hypersensitivity to its components. A 3.5-year-old healthy boy was immunized with measles vaccine on a routine immunization day in an urban center. He had not received the same at the scheduled age of 9 months, but had not suffered from an episode of measles. He was immunized at this age with an intention to provide protection during the frequent outbreaks of measles in the area. The vaccine administered contained freeze-dried, lyophi- lized, live-attenuated measles virus, propagated on human diploid cells (Edmonston–Zagreb strain), reconstituted with distilled water according to the advice on the product label. The vaccine was administered by subcutaneous injection (0.5 mL) on the right deltoid region from a multidose vial with all aseptic precautions. Before and after reconstitution, the cold chain was maintained adequately. The patient’s 9-month-old younger brother and another infant were vaccinated at the same time from the same vial. Together with vaccination, an oral dose of vitamin A (2 mL of vitamin A oil, containing 2 lakh IU of retinol palmitate in arachis oil) was administered to these children. Four days later, the child developed pain, erythema, and vesiculation at the injection site. He was taken to a local medical practitioner who advised a topical antimicrobial cream together with analgesics. The reaction did not subside with the medication but progressed rapidly. There was no associated constitutional symptoms or generalized skin eruption. On the third day of skin lesions, local cutaneous examination showed erythema, edema with extensive eczematization, oozing, and crusting of the right deltoid region and adjacent areas of the arm, upper back, upper chest, side of the neck, and submental region (Fig. 1). Over the prominence of the deltoid, there was a circular crater-like area of about 5 cm in diameter (Fig. 1), corresponding to the original site of vaccination. There was sloughing off of the skin from the side of the neck and submental region. The area was indurated and tender, with oozing of serous fluid but without any pus. The patient’s complete hemogram was normal. The erythro- cyte sedimentation rate was 10 mm in the first hour. Culture sensitivity test from lesional fluid did not grow any organisms. Skin biopsy for histopathologic examination was suggested, but declined by the parents. The patient was advised systemic corticosteroid (1 mg/kg), tapered slowly over 2 weeks, and topical emollients. With therapy, the lesions gradually healed leaving post-inflammatory hyperpigmentation. Home visit and inquiry revealed that the other two infants immunized from the same vial of measles vaccine on that day remained healthy during the post-vaccination period. The incident of the reaction to measles vaccine was reported to the local health authorities. Discussion Cutaneous lesions following measles vaccination may be generalized or local injection site reactions. In the post- 873 ª 2009 The International Society of Dermatology International Journal of Dermatology 2009, 48, 873–874