Onychomadesis in a 9-month-old boy with hand-foot-mouth disease
© The Author(s). 2017
Received: 2 June 2017
Accepted: 4 August 2017
Published: 14 August 2017
Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis is described as a rare, late complication of hand-foot-mouth disease, which is a viral illness commonly seen in the pediatric age group. It is therefore important to elucidate the presentation of this entity, especially in the context of the hand-foot-mouth disease.
We report a case of onychomadesis in a 9-month old Lebanese boy who presented to the emergency department with rapidly progressing nail changes involving all four extremities. These changes appeared few days after the healing of cutaneous lesions of hand-foot-mouth disease.
This case highlights the importance of recognizing the association between onychomadesis and hand-foot-mouth disease in order to avoid unnecessary treatment and to reassure the patient’s parents.
Onychomadesis, characterized by shedding of nails from the proximal nail beds, is often idiopathic, but can also be linked to certain medications, systemic illnesses, and viral infections including hand-foot-mouth disease (HFMD). HFMD is a common contagious disease, affecting mainly children under the age of 10, but also reported in adults . This disease is characterized by vesicular rashes on hands, feet, and buttocks and ulcers in the oral mucosa, accompanied by occasional fever . Enterovirus 71 and coxsackievirus A16 are the most common causative agents associated with the condition . Onychomadesis, a rare complication occurring 4 to 6 weeks after the onset of the disease, is usually self-limited and does not require treatment . Common nail abnormalities include leukonychia and Beau lines as well as partial or complete nail shedding . The mechanism of onychomadesis remains to be elucidated, although onychomadesis usually implies that nail matrix proliferation was temporarily inhibited. Bettoli et al. suggest that periungual inflammation secondary to viral infection may be induced directly by viruses or indirectly by immunocomplexes and consequent distal embolism , while Cabrerizo et al. consider that the nail matrix is directly damaged by viral replication, based on the presence of Coxsackie virus 6 in shed nails .
In this paper, we describe the presentation of onychomadesis in a boy previously diagnosed with HFMD.
To our knowledge, this is the first case of onychomadesis to be reported from the Middle East. We ought to highlight the importance of recognizing the association between HFMD and onychomadesis in order to avoid unnecessary treatment and to reassure the patient’s parents. Nevertheless, it is important to note that this is a rare presentation, and a thorough history and physical exam are necessary to identify the correct etiology and rule out other serious pathologies.
No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.
IM, RM, and MA prepared the literature review. IM was responsible for the manuscript writing, preparation, and submission. All authors read and approved the final manuscript.
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Written informed consent was obtained from the patient’s guardian/parent/next of kin for the publication of this report and any accompanying images.
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