We thank Dr. Cunha for his comments and appreciate the opportunity to emphasize important points that he highlights.
We agree that measles is a systemic illness with important extradermatologic manifestations that are critical to the diagnosis, and that the nondermatologic manifestations often precede the rash and serve to distinguish measles from other systemic illnesses. As discussed in our review, the respiratory prodrome of cough, coryza, and conjunctivitis is very distinctive and serves as an important clue to the diagnosis. Likewise, we acknowledge the importance of gastrointestinal findings in measles and note appendicitis as an important complication that is well described. Although Koplik spots are pathognomonic, we do stress that these often are not present at the time of presentation.
Finally, we agree that measles is a clinical diagnosis, and that the clinical manifestations beyond the dermatologic manifestations noted in our review and highlighted by Dr. Cunha are extremely helpful to the clinician in considering the diagnosis.
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