Psoriasiform eruptions during Kawasaki disease (KD): A distinct phenotype

Abstract

Background A psoriasis-like eruption develops in a subset of patients with Kawasaki disease (KD). Objective To systematically compare KD-associated psoriasiform eruptions with classic psoriasis and the outcomes of KD in children with and without this rash. Methods This was a retrospective study of 11 KD cases with a psoriasiform eruption matched 1:2 by age, gender, and ethnicity with psoriasis-only and KD-only controls. Genotyping was performed in 10 cases for a deletion of two late cornified envelope (LCE) genes, LCE3C_LCE3B-del, associated with increased risk for pediatric-onset psoriasis. Results Similar to classic psoriasis, KD-associated eruptions were characterized clinically by well-demarcated, scaly pink plaques and histopathologically by intraepidermal neutrophils, suprabasilar keratin 16 expression, and increased Ki-67 expression. They showed less frequent diaper area involvement, more crust and serous exudate, and an enduring remission (91% vs. 23% with confirmed resolution; p < 0.001). Frequency of LCE3C_LCE3B-del and major KD outcomes were similar between cases and controls. Limitations The study was limited by the small number of cases, treatment variation, and availability of skin biopsy specimens. Conclusions Although the overall clinical and histopathologic findings were similar to conventional psoriasis, this appears to be a distinct phenotype with significantly greater propensity for remission. No adverse effect on KD outcomes was noted.

Kawasaki disease for the paediatric dermatologist: skin manifestations and new insights into the pathophysiology

“…1c). [4][5][6] Vesiculobullous lesions are unusual and should prompt consideration of an alternative diagnosis. 1,3,7 In studies, skin biopsies performed on exanthema showed extensive oedema along with mononuclear cell infiltration, mainly CD4+ T lymphocytes and CD13+ macrophages in the papillary dermis and high levels of interleukin (IL)-1 and tumour necrosis factor (TNF)-a as evidence of pro-inflammatory cytokine production leading to a vigorous T-cell response.…”

Streptococcal‐induced Kawasaki disease of the psoriasiform phenotype in a young adult

“…Streptococcal superantigens have already been implicated in the induction of the TH1/TH17/TH22 immunologic profiles of guttate psoriasis . We hypothesize that this patient, who exhibited elevated anti‐streptolysin O and anti‐Dnase titers, experienced immunologic sequela that induced this Kawasaki psoriasiform phenotype, now defined as a distinct entity possibly linked to bacterial superantigens. Further investigation into the pathophysiology of this process is needed.…”

“…The patient's skin pathology exhibited features of guttate psoriasis, which has been described in association with Kawasaki disease . A recent retrospective review described 11 cases with intraepidermal neutrophils, suprabasilar keratin 16 expression, and increased Ki‐67 expression on skin biopsy. These patients had a greater propensity for remission when matched to controls (91% vs. 23% with confirmed resolution; P < 0.001).…”

Cyclosporine for refractory Kawasaki disease with psoriasiform eruption

“… 3 Approximately only 1.3% of patients with KD will develop a psoriasiform pattern. 4 This psoriasiform eruption may develop during or after the acute phase of the disease. 2 Treatments for KD involve aspirin (ASA) and intravenous immune globulin (IVIG) as first-line therapies.…”