Nail Matrix Arrest Following Hand‐Foot‐Mouth Disease: A Report of Five Children

Abstract

Hand-foot-mouth disease (HFMD) is a contagious enteroviral infection occurring primarily in children and characterized by a vesicular palmoplantar eruption and erosive stomatitis. Nail matrix arrest has been associated with a variety of drug exposures and systemic illnesses, including infections, and may result in a variety of changes, including transverse ridging (Beau's lines) and nail shedding (onychomadesis). The association of HFMD with Beau's lines and onychomadesis has not been reported previously. Five children, ages 22 months-4 years, presented with Beau's lines and/or onychomadesis following physician-diagnosed HFMD by 3-8 weeks. Three of the five patients experienced fever with HFMD, and none had a history of nail trauma, periungual dermatitis, periungual vesicular lesions, or a significant medication intake history. All patients experienced HFMD within 4 weeks of one another, and all resided in the suburbs of the Chicago metropolitan area. In all patients the nail changes were temporary with spontaneous normal regrowth. The mechanism of the nail matrix arrest is unclear, but the timing and geographic clustering of the patients suggests an epidemic caused by the same viral strain.

“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

“…Onychomadesis associated with HFMD most often occurs 3 to 8 weeks after HFMD is diagnosed. 35,36 It is generally asymptomatic, and the nails typically regrow normally within several months.…”

Onicomadesis asociada a la enfermedad de boca, mano y pie

“…1 Es consecuencia de la detención de la función de la matriz ungular, 2 con la correspondiente inhibición de la proliferación celular 3 y es rara en los niños. 2 Puede ser secundaria a enfermedades sistémicas que cursan con fiebre e insuficiencia renal, o deberse a deficiencias nutricionales, dermatitis de contacto alérgica, 4 dermatosis ampollares, fármacos (penicilina, cefalosporinas, carbamazepina), paroniquia, estrés, dismenorrea, distrofia simpática refleja, enfermedad de Kawasaki, candidiasis, quimioterapia y radioterapia.…”

Not only fever and palmoplantar vesicular eruption

“…HFMD is a common benign self-limiting childhood viral illness associated with coxsackievirus A16 (CV-A16) and enterovirus 71 (EV-71) infections [2]. Atypical HFMD is a possible cause of onychomadesis (growth cessation of longer-term nail and/ or nail matrix causes nail shedding from the proximal portion) [3]. The incidence of this phenomenon was not reported [4].…”

“…The incidence of this phenomenon was not reported [4]. It was first described in 2000 in five children, and it has since been associated to several enterovirus serotypes, especially CV-A16 [3]. The underlying mechanisms is still unclear.…”

“…Davia et al proposed that the virus, through direct action on the nail matrix keratinocytes, would probably lead to arrest it [1]. The temporal association, with 3-9 weeks interval, between disease and nail injury suggestes the causal relationship [1,3,4]. Complete nail regrowth is typically 1-4 months later [1].…”