From the Guidelines
No, the rash associated with Kawasaki disease is not concurrent with recovery but rather appears during the acute phase of the illness. The polymorphous rash typically develops within the first five days of fever onset and is one of the principal diagnostic criteria for Kawasaki disease, as noted in the American Heart Association guidelines 1. This rash can take various forms including maculopapular, erythema multiforme-like, or scarlatiniform patterns, and often affects the trunk and extremities. According to the guidelines, the rash tends to appear within the first five days of illness and is truncal, often with accentuation in the groin region 1. As the disease progresses toward recovery, usually after treatment with intravenous immunoglobulin (IVIG) and aspirin, the rash begins to resolve along with other acute symptoms. During the convalescent phase, approximately 1-3 weeks after onset, patients may experience desquamation (peeling) of the skin, particularly on the fingers and toes, which is actually a sign of recovery rather than active disease, as described in the study published in Circulation 1.
Some key points to consider in the diagnosis and treatment of Kawasaki disease include:
- The classic diagnosis of Kawasaki disease has been based on the presence of 5 days of fever and 4 of the 5 principal clinical features 1
- The fever typically is high spiking and remittent, with peak temperatures generally 39°C (102°F) and in many cases 40°C (104°F) 1
- First-line treatment for Kawasaki disease is IVIG in a dose of 2 g per kg of body weight in a single infusion, as recommended by the American Heart Association guidelines 1
- For treatment of Kawasaki disease, high-dose aspirin (80 to 100 mg per kg per day, divided into four doses) should be given with IVIG 1
Overall, the rash associated with Kawasaki disease is an important diagnostic criterion, but it is not a sign of recovery. Rather, it is a symptom of the acute phase of the illness, and its resolution is a sign of improvement.
From the Research
Kawasaki Disease and Rash
- The rash associated with Kawasaki disease is one of the key symptoms, along with fever, cervical lymphadenopathy, bilateral nonexudative conjunctivitis, oropharyngeal mucosal changes, and erythema of the hands and feet followed by desquamation 2.
- The disease has a triphasic course, including an initial phase of acute illness marked by high fever, conjunctival injection, oral changes, and erythematous rash, a second subacute phase with desquamation of rash, and a third phase where all signs of clinical illness subside 3.
- The rash is typically present during the acute phase of the illness and may desquamate during the subacute phase 4, 3.
- There is no direct evidence to suggest that the rash is concurrent with recovery, as recovery is typically marked by the subsidence of all clinical symptoms, including the rash 2, 3.
Recovery and Clinical Symptoms
- With treatment, including high doses of aspirin and intravenous immunoglobulin, the clinical symptoms of Kawasaki disease, including the rash, typically subside 2, 5.
- Recovery is marked by a decline in acute findings and the subsidence of clinical illness 3.
- Long-term follow-up is necessary to monitor for potential cardiovascular sequelae, including coronary artery aneurysms 5, 4.