An 11-year-old boy is brought to the office by his mother following the occurrence of a slight fever and mouth irritation accompanied by blisters on his hands and feet that developed approximately 3 weeks prior to this visit. His mother is also concerned about recent nail changes affecting several fingers. Examination reveals distal whitening and crumbling of 3 fingernails.
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Hand, foot, and mouth disease (HFMD) is a common infectious condition caused by a virus, most frequently by strains of enterovirus (EV-A71) and coxsackie (A6, A10, A16).1 Young children are predominantly affected and clinical manifestations follow a short incubation period.2
Disease manifestations may include slight fever, malaise, and sore mouth. Lesions of the mouth, hands, and feet begin as erythematous macules that become vesicular. Most cases are self-limiting, although serious sequelae, including mortality, have been reported rarely.3
Nail changes can occur with HFMD. These include shedding of the nail plate4 and involvement of the proximal nail fold.5 Nail changes usually occur several weeks after infection and are temporary, with spontaneous regrowth of healthy nails occurring within 4 months.
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
- Lu J, Zeng H, Zheng H, et al. Hand, foot, and mouth disease in Guangdong, China, in 2013: new trends in the continuing epidemic. Clin Microbiol Infect. 2014;20:O442-O445.
- Yu JG, Liu YD, Qiao LY, Wang CJ. Epidemiological study and clinical analysis of 931 children with hand, foot, and mouth disease in Yantai [in Chinese]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2011;25:374-376.
- Chan LG, Parashar UD, Lye MS, et al. Deaths of children during an outbreak of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group. Clin Infect Dis. 2000;31:678-683.
- Osterback R, Vuorinen T, Linna M, Susi P, Hyypiä T, Waris M. Coxsackievirus A6 and hand, foot, and mouth disease, Finland. Emerg Infect Dis. 2009;15:1485-1488.
- Shikuma E, Endo Y, Fujisawa A, Tanioka M, Miyachi Y. Onychomadesis developed only on the nails having cutaneous lesions of severe hand-foot-mouth disease. Case Rep Dermatol Med. 2011;2011:324193.