We report the clinical and histological changes of small pustules that developed in four patients with Kawasaki disease (KD). The small pustules were superimposed on the urticarial erythem and symmetrically arranged on the genital area, buttocks, axillae, and extensor surface of the extremities. These lesions showed spongiform pustules histologically and were different from miliarial pustules. Reviewing previous reports, the clinical and histological characteristics of pustules in KD are summarized herein. This study indicates that small pustules underwent the consecutive changes related to the generalized polymorphous exanthem in KD.