K

KAWASAKI DISEASE (MUCOCUTANEOUS LYMPH NODE SYNDROME)

An acute multisystemic vasculitis of unknown aetiology (? infective) in children usually <5 yrs presenting with an acute febrile illness. Typically targets coronary arteries.

Diagnostic features and criteria

Fever persisting for more than 5 d plus at least 4 of:

• bilateral conjunctival congestion (non-purulent)

• Mucous membrane changes—dryness, redness and cracking of the lips ± erythema of tongue, buccal mucosa

• maculopapular polymorphic rash esp. trunk, genitalia

• cervical lymphadenopathy >1.5 cm usu. unilaterial

• erythema and swelling of palms and soles

Followed by desquamation of fingertips (a characteristic)

Diagnosis with 5/6 features or 4/6 plus evidence of coronary aneurysm (plus exclusion of other diseases). It is a clinical diagnosis.

Above features may be variable/incomplete and not all present concurrently.

No specific test but elevated ESR, neutrophilia, thrombocytosis and various +ve antibody tests (e.g. antiendothelial cell). Generally benign and self-limiting but early diagnosis is important to prevent life-threatening complications, esp. coronary aneurysms (15–30% in untreated) and also myocardial infarction, pericarditis and myocarditis.

Management

• Echocardiography and ECG are indicated

• Treat with aspirin (start ASAP) and high-dose IV normal gammaglobulin.

• Corticosteroid use is controversial; check with consultant if necessary.

• Most children recover and the overall mortality is <3%; often benign and self limiting

KELOID OR HYPERTROPHIC SCAR

Various treatment methods

Prevention: Avoid procedures on Keloid-prone individuals. Use compression and silicone dressings.

Management of scarring: options

• Intradermal injection of corticosteroids in early stages (most commonly used, several might be required)

• Silicon sheets/gels applied over long periods

• Potent topical corticosteroids (best under occlusion)

• Intralesional cytotoxics (e.g. fluorouracil)

• Liquid nitrogen may help flatten keloid

• Laser (pulse dye laser) may help reduce redness

• Consider re-excision of hypertrophic scarring

KERATOACANTHOMA

Management

• Remove by excision perform biopsy (at least 2–3 mm margin)

• If clinically certain—curettage/diathermy

• Treat as SCC (by excision) if on lip/ear

Note: Can be misdiagnosed instead of SCC.

KERATOSES (SOLAR AND SEBORRHOEIC)

Seborrhoeic keratoses

Management

• Usually nil apart from reassurance

• Does not undergo malignant change

• Can be removed for cosmetic reasons

• Light cautery to small facial lesions

• May drop off spontaneously

• If diagnosis uncertain, remove for histopathology

Decolourisation or removal:

• liquid nitrogen (regular applications, e.g. every 3 wks) or

• concentrated phenol solution (with care) repeat in 3 wks or

• trichloracetic acid: apply to surface and instil with multiple small needle pricks (25 g). Repeat twice wkly for 2 wks.

Solar keratoses

Management