​Dermatology - Kawasaki Disease

​Dermatology - Kawasaki Disease 
Kawasaki disease is a sudden and intense sickness characterized by fever in infants and children.

Phase I: Acute Febrile Period: The sudden start of a prolonged period of high fever lasting approximately 12 days, accompanied by symptoms such as diarrhea, arthritis, swollen lymph nodes, and sensitivity to light.
Phase II, known as the Subacute Phase, poses the greatest danger of sudden death and lasts for a further 2-3 weeks. During this phase, individuals experience symptoms such as fever, increased platelet count, skin peeling, joint inflammation, joint pain, and inflammation of the heart.
Phase III, known as the Convalescent Period, occurs 8-10 weeks following the commencement of the illness. During this phase, all indications of the sickness completely disappear and the death rate is minimal. The cessation of disease occurs when the eosinophil sedimentation rate reverts to its normal level.

The erythema typically begins on the palms and soles and then spreads to the trunk and extremities, appearing as red patches that can develop into hives-like lesions (most frequently observed), a rash resembling measles (common), or a rash resembling scarlet fever or erythema multiforme (less than 5% of cases). The perineum continues to exhibit persistent erythema in the form of confluent macules progressing to plaque-type lesions, even after other symptoms have resolved. Hand/foot edema is characterized by a pronounced and darkened swelling, accompanied by redness, and affecting the fingers in a spindle-like manner.
The bulbar conjunctival injection commences 48 hours after the start of fever and persists for the duration of the fever.
The lips exhibit a red coloration, are dry, and have cracks, accompanied by widespread redness of the oral cavity and a tongue resembling a "strawberry". Desquamation occurs after a fever, starting at the junction of the nails and the tips of the fingers and toes. Then, layers of the epidermis on the palms and soles of the feet are lost. During the recovery phase, one may observe transverse grooves on the nails.


The diagnosis is established when an individual experiences a fever lasting for five consecutive days, with temperature spikes exceeding 39.4°C, and no other identifiable cause. Additionally, at least four out of five specific criteria must be met. The symptoms include: (1) redness in both eyes; (2) red and cracked lips or throat, or a tongue that looks like a strawberry; (3) redness and swelling of the hands, feet, or all over the body, or peeling skin around the nails; (4) a widespread rash that looks like scarlet fever or red bumps, and eye inflammation; and (5) swollen lymph nodes in the neck measuring at least 1.5 cm. The differential diagnosis comprises various conditions such as adverse cutaneous drug eruptions, juvenile rheumatoid arthritis, infectious mononucleosis, viral exanthems, leptospirosis, Rocky Mountain spotted fever, toxic shock syndrome, staphylococcal scalded-skin syndrome, erythema multiforme, serum sickness, lupus, and reactive arthritis.

Admit the patient to the hospital and closely observe for any cardiovascular complications. Administer intravenous immunoglobulin at a dosage of 2 grams per kilogram in a single infusion lasting 10 hours. Additionally, provide aspirin at a dosage of 100 milligrams per kilogram per day until the fever subsides or until day 14. Afterward, reduce the aspirin dosage to 5 to 10 milligrams per kilogram per day until the eosinophil sedimentation rate returns to normal. Glucocorticoids are linked to an increased incidence of coronary aneurysms and are hence contraindicated.