Enanthema is a rash that affects the mouth. It appears in certain viral diseases, most often childhood.

What is it ?

The enanthema – in opposition to the exanthema which affects the skin – is a localized rash on the mucous membranes, in the mouth and the palate.

How to recognize the enanthema?

The enanthema is manifested by the appearance of small red spots in the mouth and / or the soft palate. Depending on the infection in question, it can take on different characteristics: white spots, canker sore, ulceration, etc.

It can accompany the exanthema (rash) as well as other symptoms characteristic of a viral attack: fever, flu-like syndrome, presence of lymphadenopathy (lymph nodes).

Risk factors

Childhood eruptive fevers being the source of the vast majority of enanthemums, early childhood is a risky period.

Measles

One of its clinical manifestations of measles is a characteristic enanthema called “Köplik’s sign”. These are white spots on the inner sides of the cheeks, on the molars, with an inflammatory halo, appearing a few days after the prodromal phase of measles (high fever, eye and respiratory signs).

The scarlatine

Caused by beta-hemolytic streptococcus of group A, scarlet fever manifests in particular by an enanthem of the tongue: first covered with a thick white coating, it then presents a depapillation from the periphery to the center, then takes a red color raspberry after a few days.

Hand-foot-mouth syndrome

Caused by the Coxsackie virus, hand-foot-mouth syndrome manifests itself in particular by a vesicular enanthem of the mouth: redness appears in the followed by small papules (small red dots) around the tongue, on the gums and inside cheeks.

Kawasaki syndrome

Also called febrile adeno-cutaneous-mucous syndrome, this serious disease manifests itself among other clinical signs (fever, conjunctivitis, rash, edema of the extremities) by a pharyngeal enanthema, without aphtha, ulceration, or bubble, frequently associated with a raspberry tongue. and cheilitis (inflammation of the lip).

Its causes are not well known. A predisposing genetic ground and the interaction of the environment, probably of an infectious nature are evoked. The majority of affected children are under 5 years of age, with a peak incidence around the age of 1 year.

The risks are those of the disease pathology in question.

Measles can cause serious complications in infants under 1 year old and frail people: pneumonia, liver and kidney damage, encephalitis.

The complications of Kawasaki syndrome are primarily cardiovascular: myocarditis, and pericarditis initially, coronary aneurysms secondarily. They make all the seriousness of this disease.

Since measles is viral, antibiotics are unnecessary. Treatment will only be symptomatic, mainly against fever. Close monitoring is however necessary due to the risk of complications. The measles vaccine helps prevent the disease, but vaccination coverage remains insufficient in France. Since 2008, we have also observed an upsurge in measles cases.

Scarlet fever requires antibiotic treatment. There is no vaccine against scarlet fever. Only simple hygiene measures (hand washing in particular) can limit contamination.

The hand-foot-mouth syndrome being of viral origin, the treatment is only symptomatic: antipyretics in case of fever, antiseptic solution to be applied to the skin if the vesicles are numerous, oral rehydration solutions (ORS) to avoid dehydration if the child has difficulty eating and drinking.

Kawasaki syndrome requires hospitalization. The treatment is based on the administration of polyvalent immunoglobulins IV in order to stop the inflammatory process and prevent heart damage. Echocardiographic monitoring is also carried out.