Koplik Spots: A Clinical Sign with Epidemiological Implications for Measles Control

Dermatological Signs and Symptoms of Measles: A Prospective Case Series and Comparison with the Literature

“…Koplik spots, ‘white grey papules on a red background’ [6], are also described to appear at the beginning of the disease on the buccal mucosa opposite the lower molars and involving the rest of the mucosa afterwards. Different texts say that Koplik spots are pathognomonic for measles [7,8,9]. However, they were also observed with parvovirus B 19 infection [10,11].…”

“…The time of appearance is either described as being generally in the prodromal stage [6,12] or just early in the course of infection [13] or ‘a couple of days before the rash’ [12]. In other sources, they are said to appear on the second or third day of the prodromal stage [4,7,14] or 1 [9] or 2 [15] days before the onset of the skin eruption. Concerning duration, the literature offers two opinions: Koplik spots are either described as persisting until the onset of the exanthema for 2–3 days [7,9,15] or just ‘for several days’ [14].…”

“…In other sources, they are said to appear on the second or third day of the prodromal stage [4,7,14] or 1 [9] or 2 [15] days before the onset of the skin eruption. Concerning duration, the literature offers two opinions: Koplik spots are either described as persisting until the onset of the exanthema for 2–3 days [7,9,15] or just ‘for several days’ [14]. Most literature locates Koplik spots to the buccal mucosa opposite the upper molars [6,12,14,15] spreading from there to the whole buccal mucosa.…”

Koplik spots revisited

“…They may also appear on conjunctival folds or on vaginal or gastrointestinal mucosa. 3 The bluish-red halo is caused by a collar of dilated veins around the submucosal gland duct, whereas the white portion is likely the result of the destruction of glandular epithelial cells. 4 Koplik spots are present in more than 70% of patients with measles, 3 and "the height of the eruption is reached just as the skin eruption has appeared and is spreading."…”

“…3 The bluish-red halo is caused by a collar of dilated veins around the submucosal gland duct, whereas the white portion is likely the result of the destruction of glandular epithelial cells. 4 Koplik spots are present in more than 70% of patients with measles, 3 and "the height of the eruption is reached just as the skin eruption has appeared and is spreading." 5 As the widespread rash progresses, the rash on the mucosal membrane loses "the character of discrete spotting and [becomes] a diffuse red background with innumerable bluish white specks scattered on its surface."…”