Red Palms in Kawasaki Disease
Yes, red palms are a classic and well-established clinical feature of Kawasaki disease, specifically manifesting as palmar erythema during the acute phase of illness. 1
Diagnostic Significance of Red Palms
Red palms and soles are one of the principal diagnostic criteria for Kawasaki disease, appearing as part of the "extremity changes" category used to establish the diagnosis. 2, 3
Specific Presentation Pattern
Acute phase findings include erythema (redness) of the palms and soles, accompanied by edema (swelling) of the hands and feet with sharp demarcation at the wrists and ankles. 2, 3
The palmar and plantar erythema typically appears during the first 5-10 days of illness, coinciding with the high fever phase. 4
This erythema is followed by periungual desquamation (peeling around the nails) starting approximately 2-3 weeks after fever onset during the convalescent phase. 3
Role in Clinical Diagnosis
The American Heart Association diagnostic criteria require fever lasting at least 5 days plus at least 4 of 5 principal features, with extremity changes (including red palms) being one of these five key features. 2, 3
Red palms alone do not confirm Kawasaki disease, as this finding must be interpreted alongside other clinical features including bilateral conjunctival injection, oral mucosal changes, polymorphous rash, and cervical lymphadenopathy. 1
The combination of red palms with swollen hands/feet and the characteristic sharp demarcation at wrists/ankles is highly suggestive of Kawasaki disease when present with prolonged fever. 2
Clinical Pitfall to Avoid
Not all clinical features appear simultaneously in Kawasaki disease. 3 A careful review of the patient's entire clinical course over the preceding days is essential, as the palmar erythema may have been present earlier even if it has resolved by the time of evaluation. The subsequent desquamation phase can provide retrospective diagnostic confirmation. 3
Differential Consideration
While red palms occur in Kawasaki disease, this finding is not pathognomonic and can occur in other conditions including hand-foot-mouth disease (though HFMD presents with vesicular rather than diffuse erythematous lesions), drug reactions, and other infectious processes. 5 However, the specific pattern of diffuse palmar erythema with edema and sharp demarcation at the wrists, occurring in the context of prolonged high fever, strongly suggests Kawasaki disease. 2, 3