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Background: Kawasaki's disease may have numerous atypical forms and these must be recognized in order to avoid delay of treatment. We report a case of psoriasis, first pustular and then guttate, occurring during Kawasaki's disease, and discuss a common pathophysiological mechanism., Case-Report: A 3 year-old boy was seen for a febrile exanthema suggestive of Kawasaki disease (bilateral conjunctivitis, red and fissured lips, palmoplantar erythema, scarlet fever-like rash and perineal desquamation) associated with pustular lesions. A biopsy specimen of a pustular area showed histological features consistent with the diagnosis of pustular psoriasis. No coronary abnormality was found. The child was treated with intravenous immunoglobulins (2 g/kg) and oral aspirin (60 mg/kg/d). All the symptoms disappeared and immediate follow-up was marked by the appearance of guttate psoriasis., Discussion: Onset of psoriatic lesions during Kawasaki disease has been reported in 12 cases, either in acute phase or in immediate follow-up. Coronary complications have been found in 4 of 5 cases with acute psoriasis, suggesting a severe prognosis for this association. The hypothesis of a common pathophysiological mechanism is discussed with the intervention of a bacterial toxin acting as a superantigen and resulting in an strong activation of T-cells that leads to keratinocyte activation. The psoriatic lesions could hence be considered as a form of Köbner's phenomenon.

Introduction: The cutaneous signs of toxicomania are better known since the last two decades. We describe an original case of segmental necrotic and chronic livedo of the right arm associated with cocaine use., Observation: A 31 year-old intravenous cocaine user presented a necrotic and painful livedo of the right arm. Two years before referral, localized recurrent edema was noted without general involvement. No local (infectious, vascular) or general (dysimmunity, coagulation abnormalities) aetiologies could be found. An amorphic substance composed of mineral bodies was found in the dermis, without damage to the vessels. Dramatic improvement was obtained with simple supportive care, while intravenous injections were stopped., Discussion: The vasoconstrictive properties of cocaine have been demonstrated in Raynaud's phenomenon, ischemia, focal necrosis of the extremities, and also in liver and kidney disorders. This drug has pharmacological effects on endothelial cells and coagulation, explaining the arterial and venous thrombosis reported. The foreign bodies found in our patient probably came from an intraarterial injection. The progressive and chronic evolution, without any evidence of thrombosis at the time of examination, are suggestive of the vasoconstrictive action of chronic dermal deposits.