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Kawasaki disease-linked psoriasiform eruptions differ from classic psoriasis

Unlike conventional psoriasis among children, psoriasiform eruptions that developed during Kawasaki disease are a distinct phenotype with a tendency for remission, according to study results.

“Kawasaki disease (KD) is an acute systemic inflammatory illness causing vasculitis and potentially fatal coronary artery aneurysms in 15% to 25% of untreated children,” Ellen S. Haddock, AB, MBA, of the School of Medicine at University of California, San Diego, and colleagues wrote. “A psoriasis-like eruption develops in a small subset of patients during the acute, subacute, or convalescent phases of the disease. The eruption can have an atypical presentation and does not appear to persist, creating uncertainty over whether it represents true psoriasis.”

To compare KD-associated psoriasiform eruptions with classic psoriasis, researchers examined patients at Rady Children’s Hospital who developed a psoriasiform eruption during KD illness between Jan. 1, 1998 and Aug. 1, 2012. Patients were identified and matched 1:2 to patients of similar age, gender, and ethnicity with psoriasis-only and KD-only controls.

According to study results, of 870 children diagnosed with KD, 11 developed psoriasiform eruptions during the study period (1.3%).

Haddock and colleagues conducted genotyping in 10 of the patients for a deletion of 2 late cornified envelope (LCE) genes, LCE3C_LCE3B-del, which are linked to an increased risk for pediatric-onset psoriasis.

KD-associated eruptions were identified by clinical features such as well-demarcated, scaly pink plaques and histopathological features such a intraepidermal neutrophils, suprabasilar keratin 16 expression, and increased Ki-67 expression.

The researchers observed that diaper area involvement was less common among patients with KD-associated psoriasiform eruptions. In addition, more crust and serous exudate was documented. Overall, 91% of children experienced remission, while only 23% achieved resolution (P < .001). There was similar frequency of LCE3C_LCE3B-del and major KD outcomes between cases and controls.

“KD-associated psoriasiform eruptions appear to be a distinct phenotype, with a propensity for remission,” concluded Haddock and colleagues. “Further study of this unique overlap between psoriasis and KD may provide additional insight into the pathophysiology of these complex, immune-mediated disorders.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.