Clinical Aspects of Periungual Desquamation in Kawasaki Disease

To assess the relationship between coronary artery changes and periungual desquamation in Kawasaki disease (KD) and non - KD patients.
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.
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.
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.