Desquamation In Kawasaki Disease And Its Relationship With Coronary Artery Abnormalities

Abstract

Background Desquamation of hands and feet is a common characteristic of Kawasaki disease (KD), and occurs in 68-98% of patients diagnosed with KD. In this study, we analyzed patients’ varying desquamation levels in their hands or feet, in correlation with clinical presentation, to assess the relationship.Method We retrospectively reviewed children with KD who had follow-up visits in Kaohsiung Chang Gung Memorial Hospital’s pediatric outpatient department (OPD) during 2018 and 2019. We analyzed their age, laboratory data before intravenous immunoglobulin (IVIG) treatment, and coronary artery abnormalities (CAA) based on the desquamation level of their hands and feet.Results We enrolled a total 112 patients in the study, and 92 patients (82.1%) had hand or feet desquamation. We found the hands’ high-grade desquamation was positively associated with age and segmented neutrophil percentage (p=0.047 and 0.029, respectively) but negatively associated with lymphocyte and monocyte percentage (p=0.03 and 0.006, respectively). Meanwhile, the feet’s high-grade desquamation was positively associated with total white blood cell count (p=0.033). Furthermore, we found that high-grade hand desquamation had less probability of CAA formation compared with that of a low grade (7.1% vs. 40.8%, p=0.016). We observed no significant difference in IVIG resistance between the groups. Conclusion This report is the first to demonstrate that the desquamation level of hands or feet in Kawasaki disease is associated with different coronary artery abnormalities and laboratory findings. Physicians should be cautious of CAA formation, particularly in patients with low-grade hand peeling.

The incidence of periungual desquamation and thrombocytosis in Kawasaki disease and the importance of systematic observation in the subacute phase

“…These studies suggested that the observed incidence of desquamation may be higher because of the lack of established diagnostic and treatment guidelines and the inconsistent use of IVIG at that time. However, two studies published after 2020 reported an incidence rate of 82%, thus making it challenging to conclude a significant decrease in the incidence of desquamation compared to that previously reported ( 6 , 25 ). During our study, the carefully observed group (group I) had a desquamation rate of 85%, which was not markedly different from the rate of 87% reported in Korea in 1980 ( 26 ).…”

“…Previous studies have not established a clear correlation between desquamation, coronary anomalies, and thrombocytosis with coronary anomalies. Some papers have reported no association, while others suggest that more severe desquamation may correlate with fewer coronary complications, and increased thrombocytosis may be associated with a higher incidence of coronary complications ( 6 , 10 , 24 , 25 , 34 ). Our study has limitations in discussing the correlation between desquamation, thrombocytosis and coronary artery complications, and the outcomes of early treatment.…”