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Practice

Onychomadesis after hand-foot-and-mouth disease

Xue-ling Gan and Tang-de Zhang
CMAJ February 21, 2017 189 (7) E279; DOI: https://doi.org/10.1503/cmaj.160388
Xue-ling Gan
Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Tang-de Zhang
Department of Dermatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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A seven-year-old boy presented with a four-week history of nail shedding. The patient developed nail changes three weeks after recovering from hand-foot-and-mouth disease diagnosed by rectal swab, which was positive for human enterovirus 71. Initially, a grey-white patch appeared on the bottom of his nails and spread. Then, beginning with the lunulae, his nails shed over the course of two weeks from the bottom to the free border of the nail. Meanwhile, fresh, thin pink nails grew slowly. Physical examination showed that multiple fingernails and toenails had shed completely or partially (Figure 1). Beau lines, horizontal grooves running across the nail plates, were noted. Some nails showed a cloudlike, grey-white colour. No periungual rashes or swelling were found. We diagnosed onychomadesis following hand-foot-and-mouth disease.

Figure 1:
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Figure 1:

Partial or complete nail shedding in a seven-year-old boy who had hand-foot-and-mouth disease eight weeks earlier. Panels A–C show new nail growth, panels A, B and D show Beau lines (white arrows), and panels D and E show grey-white colour changes (black arrows).

Hand-foot-and-mouth disease typically manifests as fever and vesicles involving the hands, feet and mouth, mainly affecting children older than five years.1 Enterovirus 71 and coxsackievirus A16 are the most common causative agents among a dozen enteroviruses associated with the condition.1,2 Onychomadesis is a late complication that occurs four to six weeks after the illness onset.2,3 It is usually self-limited and requires no treatment.4 Nail abnormalities range from leukonychia and Beau lines to partial or complete nail shedding.5 The pathogenesis of onychomadesis associated with hand-foot-and-mouth disease is incompletely understood. It may involve brief inhibition of nail-matrix proliferation caused by periungual inflammatory reactions or enteroviruses affecting the nail matrix more directly.5

Clinical images are chosen because they are particularly intriguing, classic or dramatic. Submissions of clear, appropriately labelled high-resolution images must be accompanied by a figure caption. A brief explanation (300 words maximum) of the educational significance of the images with minimal references is required. The patient’s written consent for publication must be obtained before submission.

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • The authors have obtained patient consent.

References

  1. ↵
    1. Huang X,
    2. Wei H,
    3. Wu S,
    4. et al
    . Epidemiological and etiological characteristics of hand, foot, and mouth disease in Henan, China, 2008–2013. Sci Rep 2015;5:8904.
    OpenUrl
  2. ↵
    1. Yan X,
    2. Zhang ZZ,
    3. Yang ZH,
    4. et al
    . Clinical and etiological characteristics of atypical hand-foot-and-mouth disease in children from Chongqing, China: a retrospective study. BioMed Res Int 2015 Nov. 26 [Epub ahead of print]. doi:10.1155/2015/802046.
    OpenUrlCrossRef
  3. ↵
    1. Guimbao J,
    2. Rodrigo P,
    3. Alberto MJ,
    4. et al
    . Onychomadesis outbreak linked to hand, foot, and mouth disease, Spain, July 2008. Euro Surveill 2010;15:19663.
    OpenUrl
  4. ↵
    1. Mathes EF,
    2. Oza V,
    3. Frieden IJ,
    4. et al
    . “Eczema coxsackium” and unusual cutaneous findings in an enterovirus outbreak. Pediatrics 2013;132:e149–57.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Hardin J,
    2. Haber RM
    . Onychomadesis: literature review. Br J Dermatol 2015; 172:592–6.
    OpenUrlCrossRefPubMed
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Canadian Medical Association Journal: 189 (7)
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Vol. 189, Issue 7
21 Feb 2017
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Onychomadesis after hand-foot-and-mouth disease
Xue-ling Gan, Tang-de Zhang
CMAJ Feb 2017, 189 (7) E279; DOI: 10.1503/cmaj.160388

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Onychomadesis after hand-foot-and-mouth disease
Xue-ling Gan, Tang-de Zhang
CMAJ Feb 2017, 189 (7) E279; DOI: 10.1503/cmaj.160388
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