Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a self-limited, multisystem vasculitis that affects infants and children. The disease occurs primarily in children under the age of 6. It is classically characterized by fever lasting at least 5 days (usually longer) plus 4 of the 5 following criteria:

• Conjunctival injection without exudate
• Red lesions of the mouth or pharynx
• Acute hand and foot edema followed by peeling
• Polymorphous cutaneous eruption
• Lymphadenopathy (usually cervical)

KD often presents with significant perineal erythema and subsequent desquamation over 2 days before development of diagnostic features of the disease. Careful evaluation and close follow-up is necessary for identification of other subtle clinical features suggestive of KD.

The most significant and potentially life-threatening complications are cardiovascular. Pericarditis, myocarditis, coronary arteritis, and endocarditis leading to arrhythmias can occur as early as 7 days from the onset of fever.

A multisystem inflammatory syndrome potentially linked to COVID-19 has been reported in children and young adults; clinical features include Kawasaki-like and toxic shock syndrome-like presentations.

Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. A variety of dermatologic conditions causing erythema of the perineum, including KD, should be considered when sexual abuse is suspected. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign anogenital skin conditions.