Author | Lightnews

Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Jul 11

Speaking now with our wonderful panel of speakers at #aadinnovation2025!

Come join us for “what’s new in complex dermatology!”

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Apr 7

::Listening to music in the car::

7: this is catchy!

Me: oh yeah?

7: yeah! My feet won’t stop wiggling!

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Apr 1

My last day on the medicine service (for now) means an end to our running “Rash of the Day!”

Until next time!

#dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 29

Haha, usually I'd just take care of it with my medicine team to spare the derm team the consult. I actually think it's also a nice learning experience for the IM team (but I'm probably the only one that thinks that)...

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 28

Getting my dermato-stethoscope ready for this weekend of joint internal medicine and dermatology inpatient calls!

Going to try real hard to avoid consulting myself...

#dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 27

Yes! I’m starting to use it and hoping it’s a game changer

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 26

Quibble away! What say you about DRESS treatment! I want to learn!

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 26

You know this #medderm is on the medicine service when this board appears…

#dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 10

Thanks to this MGH dream team for joining for today’s session on advanced therapeutics for complex dermatologic disease!

Didn’t get him in the group pic, but thanks also to @misharosenbach.bsky.social who had to run! Thanks to UPenn for loaning him to us for the afternoon ;)

#dermsky #medsky

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Reposted by Steven Chen, MD MPH MS-HPEd

Misha Rosenbach, MD @misharosenbach.bsky.social · Mar 7

@drestherfreeman.bsky.social welcome to @bsky.app ! #DermSky
@drsteventchen.bsky.social @drjohnbarbieri.bsky.social @roxanadaneshjou.bsky.social #MedSky #IDSky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 6

I’ll be speaking at #aad2025. Come join me!

Friday: C002 - conquer the boards, core
C006 - conquer the boards, applied
Monday: S053 - consultative dermatology for the hospitalized patient
S066 - advanced therapeutics for complex disease
F099 - skin and systemic malignancy

#dermsky #medsky

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Reposted by Steven Chen, MD MPH MS-HPEd

Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

For better or for worse (worse), MEASLES are back, so here's a #skytorial on recognizing this once thought eradicated disease.

MEASLES: a tutorial!

#dermsky #medsky #MedEd
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Based on what I see, patients would be contagious around when fever and other symptoms start, so I think theoretically you could have viral shedding leading to contagiousness prior to those symptoms but it should be around the same time. If others know please chime in!

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Reposted by Steven Chen, MD MPH MS-HPEd

Misha Rosenbach, MD @misharosenbach.bsky.social · Mar 2

Sadly very important tweetorial from @drsteventchen.bsky.social re: measles
#IDsky #DermSky #MedSky
👇🏼

Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

For better or for worse (worse), MEASLES are back, so here's a #skytorial on recognizing this once thought eradicated disease.

MEASLES: a tutorial!

#dermsky #medsky #MedEd
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

So to recap:
✅Measles is super contagious
✅rash occurs 4 days after symptom onset, 2 weeks after exposure
✅rash is morbiiliform and spread top down
✅also can see Koplik spots, cough, coryza, conjunctivitis, fever
✅vaccines save lives

Thanks for joining!
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Finally, measles is more common with more serious complications in younger kids (<5), especially the unvaccinated. Patients go on to have otitis media, encephalitis, and can even die from this disease.
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

And as someone who sees a LOT of morbilliform eruptions, my personal plan is to remember to look in the mouths of my patients, ask about how the rash spread (top to bottom), and paying particular attention to other symptoms like cough, coryza, and conjunctivitis!
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

So what can we do? Well, vaccination has always been the best way to prevent measles. BUT, your immunity can wane after immunization, so that means even in a fully vaccinated individual, we shouldn't forget about measles on the ddx if you see this constellation of symptoms!
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Patients are thought to be contagious from symptom onset to 4 days after the rash (so basically a little over a week surrounding the rash).

The virus is transmitted through respiratory droplets that can linger in the air for hours!
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

In patients with darker skin, the redness is less obvious, and just looks like skin colored or darker bumps.
cdc.gov/measles/sign...
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Unlike a drug rash, measles often starts up top and moves down (cephalocaudal), whereas drug rashes start on the chest & move out often.

This also means measles affects the face often, whereas drug rashes can often spare the face.
cdc.gov/measles/sign...
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Then ~4 days after symptoms started, the rash pops up.

The term we use to describe a classic "measles-like" rash is "morbilliform." This means 3-4 mm pink papules that coalesce into plaques. That probably sounds familiar because that's how we describe regular ol' drug rashes!
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Koplik spots are whitish/reddish papules that are commonly in the buccal mucosa, but can also be on the palate itself.

These are thought to be pathognomonic for measles!

PC: onlinelibrary.wiley.com/doi/10.1111/...
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

After exposure, measles usually has an ~ 10 day incubation period, and then symptoms start with a fever, and the 3 C's: Cough, Coryza (runny nose), and Conjunctivitis.

2-3 days after symptoms starts, you can also see Koplik spots in the mouth.

This is all BEFORE the rash!
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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · Mar 2

Measles is caused by a ssRNA virus in the Paramyxoviridae family. It's HIGHLY contagious. It has a higher primary and secondary attack rate than Covid (meaning getting measles after an exposure is easier than Covid). Then transmitting it to close contacts later is ALSO easier!
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