KOPLIK SPOTS: CHARACTERISTICS, CAUSES AND TREATMENT - MEDICINE - 2025

The Koplik spots are small lesions in the oral mucosa related to infection by measles virus. These marks appear two to three days before the typical measles rash and some authors consider them a pathognomonic sign of the disease.

They are named after the American pediatrician Henry Koplik, who described them in 1896 through a small medical publication. Dr. Koplik not only established its direct relationship with measles, but also noted its early onset and its usefulness in differentiating measles from other childhood diseases that cause rash.

However, independent researchers say that 50 years earlier there was already a description of these injuries. Reubold mentioned them in some cases and even Johann Andreas Murray, a famous Swedish physician, spoke of these injuries in his publications at the end of the 18th century; so did Gerhardt, Flindt, and Filatov before Koplik.

The truth is that these injuries are typical of measles and help a lot at the time of making the diagnosis. Depending on the associated symptoms, they may or may not require specific treatment, although in most cases they disappear without the application of any medical therapy.

characteristics

Koplik's spots appear exclusively on the oral mucosa. They are located on the inside of the cheek or cheeks, at the level of the first or second molar.

They are described as spots with a white or blue-white background, of small size and irregular shape, surrounded by a slightly swollen reddish halo.

Koplik's classic publication detailed the lesions as ulcers surrounded by necrotic tissue, accompanied by neutrophilic exudate and neovascularization.

The same review provides a very sympathetic description of the lesions as "grains of salt on a wet bottom", although the truth is that the lesions are somewhat larger than a grain of salt.

Appearance

The time of appearance of the lesions is very precise. After the virus comes into contact with the body and infection occurs, it takes about 10 days for Koplik spots to appear.

The rash occurs between days 12 and 13 of infection; that is, Koplik's spots appear between 48 and 72 hours before the rash.

On the other hand, these lesions tend to disappear when the other symptoms of measles begin. In fact, it is not common to find Koplik's spots at the same time as the maculopapular rash; Therefore, if a patient presents both signs together, one must be very cautious because this association is associated with immunosuppression.

Despite being a pathognomonic sign of measles, Koplik's spots do not occur in all patients.

Analyzes published in various medical journals speak of the evident presence of these lesions in about 50% of patients with measles and about 70% when the physical examination carried out is exhaustive.

Causes

Koplik's spots are pathognomonic signs of measles; that is, they only occur in patients with this disease.

However, as mentioned in a previous section, not all patients with measles present with these marks. In addition, other conditions present similar lesions and differential diagnoses must be made.

Differential diagnostics

There are other diseases that may have among their characteristics the presence of skin rash and lesions in the oral mucosa, including the following:

Kawasaki disease

It is a systemic vasculitis whose etiology is still unknown. It occurs mostly in children under 5 years of age and is more common in males.

In addition to the rash, fever, and conjunctivitis, which also occur in measles, Kawasaki disease has oropharyngeal lesions that can be confusing.

The main difference between the oral lesions of measles and Kawasaki are size and coloration, being more voluminous and reddish in the latter. Also, in Kawasaki disease there are significant lesions on the lips that are not seen in measles.

Foot-hand-mouth syndrome

It is a seasonal disease that affects children between 6 months and 12 years of age, predominantly in tropical areas. It is caused by the Coxsackie family of viruses and its symptoms include fever, gallbladder rash, anorexia, and malaise, but the real confusion arises with lesions on the oral mucosa.

The characteristics of the lesions are very similar. In both cases they are ulcerated lesions, small and located on the inside of the cheeks. They are distinguished from Koplik's spots by being very painful, whereas measles spots do not usually cause discomfort.

Infectious mononucleosis

Caused by Epstein-Barr and Cytomegalovirus, it can share many symptoms with measles. Infectious mononucleosis presents with a skin rash that can be maculopapular, bullous, vesicular, petechial, and even purple. However, what can really confuse the medical professional is the enanthem.

Most of the mucosa of the body can be compromised in mononucleosis, including oral. The appearance of whitish lesions on both the cheeks and the palate and pharynx is not unusual; The main difference from Koplik's spots is that these lesions are larger, raised, and do not go away when the rash appears.

Scarlet fever

In addition to fever and rash, scarlet fever shares with measles the presence of lesions on the oral mucosa.

Differential diagnosis is simple, since scarlet fever lesions are petechial and are located on the uvula and palate, unlike Koplik's spots, which are located on the inside of the cheeks.

Congenital syphilis

This disease, whose origin is sexual but infects the child vertically, causes rash and oral lesions.

Mucosal manifestations differ from Koplik's spots in their presentation and size, since these are large mucous patches that even involve the lips and remain even without a generalized rash.

Stevens-Johnson syndrome

Associated with the administration of certain antibiotics used to combat systemic infections, this syndrome presents a generalized rash and lesions in the oral mucosa.

The lesions differ from Koplik's spots in their coloration, since they are purple or dark red, and by their large size.

Treatment

Koplik stains do not require specific treatment. As previously mentioned, they appear before the characteristic measles rash and disappear when it is installed. They rarely occur together and still no therapy is needed to eliminate them.

When they are injured by manipulation, either accidentally or to take a sample of the injury, topical treatments can be used to relieve discomfort, such as benzydamide, polynylpyrrolidone, or hyaluronic acid.

References

1. Steichen, Oliver and Dautheville, Sandrine (2009). Koplik spots in early measles. Canadian Medical Association Journal, 180 (5): 583.
2. Tierney, Lawrence M. and Wang, Kevin C. (2006). Koplik's Spots. The New England Journal of Medicine, 354: 740.
3. Mexican Institute of Social Security (2012). Differential diagnosis of Infectious Exanthemas in Childhood. Recovered from: imss.gob.mx
4. Publishers of the Encyclopedia Britannica (2018). Measles. Recovered from: britannica.com
5. Burkhart, Nancy (2011). Measles: Are you looking for Koplik spots? Recovered from: rdhmag.com
6. Wikipedia (2018). Koplik's Spots. Recovered from: en.wikipedia.org