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:

We sought 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 2 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 < .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.

• Authors: Ellen S Haddock, Antoanella Calame, Chisato Shimizu, Adriana H Tremoulet, Jane C Burns, Wynnis L Tom
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 75 Issue 1 Pg. 69-76.e2 (Jul 2016) ISSN: 1097-6787 [Electronic] United States
• PMID: 26946987 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Cornified Envelope Proline-Rich Proteins
• Keratin-16
• Ki-67 Antigen
• LCE3B protein, human
• LCE3C protein, human

Topics

• Adolescent
• Case-Control Studies
• Child
• Child, Preschool
• Cornified Envelope Proline-Rich Proteins (genetics)
• Female
• Genotype
• Humans
• Infant
• Infant, Newborn
• Keratin-16 (analysis)
• Ki-67 Antigen (analysis)
• Male
• Mucocutaneous Lymph Node Syndrome (complications, genetics, pathology)
• Phenotype
• Prognosis
• Psoriasis (etiology, genetics, metabolism, pathology)
• Retrospective Studies
• Sequence Deletion