Clinical aspects of periungual desquamation in Kawasaki disease

Objectives: To assess the relationship between coronary artery changes and periungual desquamation in Kawasaki disease (KD) and non-KD patients. Methods: This retrospective descriptive study was conducted through a review of records of children with KD from March 2011 to February 2016. We also analyzed non-KD subjects with desquamation. Results: Among 329 patients with KD, 177 (53.8%) had periungual desquamation. Subjects with desquamation had longer duration of fever (6.75 ± 2.43 vs. 5.63 ± 1.78 days), more frequent erythema and edema of hands/feet (72.9% vs. 51.9%), and more frequent rash (94.4% vs. 74.3%) than subjects without desquamation. They also had a higher platelet count (470420 ± 127163 vs. 351240 ± 105836, P = 0.042) and higher levels of aspartate aminotransferase (AST; 91.58 ± 62.89 vs. 55.5 ± 44.72 IU/L, P = 0.031), alanine aminotransferase (ALT; 105.39 ± 71.54 vs. 76.7 ± 91.25 IU/L, P = 0.029), and pro-brain natriuretic peptide (BNP; 1738.24 ± 584.26 vs. 1034.65 ± 754.25 pg/mL, P = 0.042). There was no difference between the two groups in development of coronary artery changes. We also analyzed 47 non-KD subjects with desquamation. These patients had fewer clinical signs (87% had one sign of KD) and shorter fever duration according to parents’ reported history, and had a lower platelet count, AST, ALT, and BNP than patients with KD. These patients had no coronary artery lesions. Conclusions: Presence of periungual desquamation is not helpful for an early diagnosis of KD and is not an independent predictor of coronary artery changes in patients with or without KD.