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Abstract
Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.
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Affiliation(s)
- Debra K Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine New York, NY, USA
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Li D, Wu Y, Xing X, Huang J, Mao A, Liu T, Rao P, Qin W, Zhang L, Feng L, Gao S, Guan X. Onychomadesis and potential association with HFMD outbreak in a kindergarten in Hubei province, China, 2017. BMC Infect Dis 2019; 19:995. [PMID: 31771520 PMCID: PMC6878681 DOI: 10.1186/s12879-019-4560-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In 2017, an outbreak of onychomadesis occurred in kindergarten H, Hubei province, China. We investigated the field to learn about the magnitude and reason of the outbreak. METHODS The case definition was that a child with onychomadesis or transverse ridging (Beau's line) in fingernails and toenails without previous traumatic or systemic disease in kindergarten H from Sep. 1st to Nov. 30th, 2017. A retrospective cohort study was carried out to analyze the epidemiological relationship between onychomadesis and the hand-foot-mouth disease (HFMD) in Primary Class #2, kindergarten H. We also performed a serological survey for neutralizing antibodies against coxsackie virus A6 (CVA6), coxsackie virus A10 (CVA10) among 15 cases and six healthy children in the kindergarten. Meanwhile, some children were carried out with routine blood, fungal microscopic and microelement tests. Indoor environment examinations had been done for all classes. RESULTS A total of 20 cases were identified in Kindergarten H. Seventy-five percent (15/20) cases occurred in Primary Class #2. Fifty-five percent of the cases (11/20) had suffered from HFMD within two months. The median time between onychomadesis and HFMD was 45 days (ranging from 31 to 58 days). A retrospective cohort study in Primary Class #2 showed the attack rate was 90.0% among 10 children who suffered from HFMD in the past two months compared to 30.0% among 20 children who didn't (Rate Ratio [RR] =3.0, 95% Confidence Interval [CI] =1.5-6.0). The positive rates of neutralizing antibodies were 66.7% for CVA6 and 26.7% for CVA10 in tested cases. The result of routine blood, fungal microscopic, microelements tests were normal in cases. The indicators of environment were within the normal range. CONCLUSION The results of this study suggested that the outbreak of onychomadesis in Hubei province was probably associated with HFMD epidemic within two months.
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Affiliation(s)
- Dan Li
- Division of Infectious Disease, Jingmen Center for Disease Control and Prevention, Jingmen, 448000, Hubei, China.,Division of Infectious Disease, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.,Chinese Field Epidemiology Training Program, Beijing, 100050, China
| | - Yang Wu
- Division of Infectious Disease, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Xuesen Xing
- Division of Infectious Disease, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Jigui Huang
- Division of Infectious Disease, Jingzhou Center Disease Control and Prevention, Jingzhou, 434000, Hubei, China
| | - Anlu Mao
- Division of Infectious Disease, Jingzhou Center Disease Control and Prevention, Jingzhou, 434000, Hubei, China
| | - Tian Liu
- Division of Infectious Disease, Jingzhou Center Disease Control and Prevention, Jingzhou, 434000, Hubei, China
| | - Ping Rao
- Jingmen Municipal Commission of Health and Family Planning, Jingmen, 448000, Hubei, China
| | - Wei Qin
- Lu'an Center Disease Control and Prevention, Lu'an, 237008, Anhui, China
| | - Lijie Zhang
- Jingmen Municipal Commission of Health and Family Planning, Jingmen, 448000, Hubei, China
| | - Luzhao Feng
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Beijing, 102206, China
| | - Shangren Gao
- Division of Infectious Disease, Jingmen Center for Disease Control and Prevention, Jingmen, 448000, Hubei, China.
| | - Xuhua Guan
- Division of Infectious Disease, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.
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The Mechanism of Onychomadesis (Nail Shedding) and Beau's Lines Following Hand-Foot-Mouth Disease. Viruses 2019; 11:v11060522. [PMID: 31174263 PMCID: PMC6630444 DOI: 10.3390/v11060522] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Nail changes, including onychomadesis (nail shedding) and Beau’s line, following hand-foot-mouth disease (HFMD) are a common emergence at the stage of late complications of HFMD. However, the exact mechanism is still unknown. Therefore, we conducted this study to elucidate the mechanism of nail changes following HFMD. Methods: We collected 11 patients suffering from onychomadesis following HFMD. Nail samples from all of them were collected. Real time reverse transcription polymerase chain reaction (RT-PCR) and sequencing for human enteroviruses (HEV) were performed. Throat swabs for RT-PCR and sequencing for HEV were performed for three cases. Results: RT-PCR demonstrated the presence of Coxackievirus A6 (CVA6) in nail samples from three patients and one with Echovirus. Conclusion: In conclusion, we believe that the major cause of onychomadesis following HFMD is that certain novel viruses, mostly CVA6, are virulent and may damage nail matrix. Direct injury caused by cutaneous lesions of HFMD around nail matrix is a minor cause. There are still other virulent HEV which may result in onychomadesis. In addition, the novel strain of CVA6 also causes atypical clinical presentations, such as adult involvement and delayed-onset palmar and plantar desquamation. Physicians should be familiar with atypical presentations caused by novel viruses to avoid misdiagnosis and even inform patients of the possibility of onychomadesis that may take place weeks later to reassure patients.
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Fölster-Holst R. [1-year-old male with "Eczema reaction" acral and in the face with mildly expressed stomatitis : Preparation for the medical specialist examination: Part 24]. Hautarzt 2018; 69:180-182. [PMID: 30374559 DOI: 10.1007/s00105-018-4280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Regina Fölster-Holst
- Campus Kiel, Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland.
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Nenoff P. Zwei Kleinkinder mit neu aufgetretener Onychomadese und Leukonychie beider Großzehennägel. Hautarzt 2017; 68:852-854. [DOI: 10.1007/s00105-017-4015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mammas IN, Theodoridou M, Kramvis A, Thiagarajan P, Gardner S, Papaioannou G, Melidou A, Koutsaki M, Kostagianni G, Achtsidis V, Koutsaftiki C, Calachanis M, Zaravinos A, Greenough A, Spandidos DA. Paediatric Virology: A rapidly increasing educational challenge. Exp Ther Med 2017; 13:364-377. [PMID: 28352303 PMCID: PMC5348700 DOI: 10.3892/etm.2016.3997] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/16/2016] [Indexed: 12/12/2022] Open
Abstract
The '2nd Workshop on Paediatric Virology', which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Maria Theodoridou
- 1st Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, Athens 11527, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women's and Children's Health, Noble's Hospital, Douglas, Isle of Man IM4 4RJ, British Isles
| | - Sharryn Gardner
- Department of Children's Accident and Emergency, Southport and Ormskirk Hospital NHS Trust, Ormskirk L39 2AZ, UK
| | - Georgia Papaioannou
- Department of Paediatric Radiology, ‘Mitera’ Children's Hospital, Athens 15123, Greece
| | - Angeliki Melidou
- 2nd Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Maria Koutsaki
- Paediatric Neurology Division, 3rd Department of Paediatrics, School of Medicine, University of Athens, ‘Attikon’ University Hospital, Athens 12462, Greece
| | - Georgia Kostagianni
- Department of Otorhinolaryngology - Head and Neck Surgery, ‘Triassio’ General Hospital, Elefsina 19200, Greece
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals, Truro, Cornwall TR1 3LQ, UK
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Marcos Calachanis
- Department of Paediatric Cardiology, ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
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Chiu HH, Wu CS, Lan CCE. Onychomadesis: A Late Complication of Hand, Foot, and Mouth Disease. J Emerg Med 2016; 52:243-245. [PMID: 27717588 DOI: 10.1016/j.jemermed.2016.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/07/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Hsiu-Hui Chiu
- Department of Dermatology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Chieh-Shan Wu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Dermatology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Dermatology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Long DL, Zhu SY, Li CZ, Chen CY, Du WT, Wang X. Late-Onset Nail Changes Associated with Hand, Foot, and Mouth Disease: A Clinical Analysis of 56 Cases. Pediatr Dermatol 2016; 33:424-8. [PMID: 27292264 DOI: 10.1111/pde.12878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the development and clinical characteristics of nail changes in hand, foot, and mouth disease (HFMD). METHODS A telephone survey was conducted with the parents of patients diagnosed with HFMD in the Fourth General Hospital of Nanhai from June to August 2013 to document nail changes within 3 months of diagnosis of HFMD. RESULTS Valid survey results were obtained from 273 cases. Definitive nail changes were identified in 56 patients (20.5%). More boys (25.8%) than girls (10.6%) (p < 0.01) showed changes. The age distribution ranged from 1 to 5 years, and nail changes were rare in children younger than 1 year of age (p < 0.01). Nail changes were usually seen 1 to 2 months after the onset of HFMD and lasted for 1 to 8 weeks, most for approximately 4 weeks. Toenails or fingernails could be affected and the changes were more likely to occur synchronously. Fingernails were more commonly involved than toenails. When both fingernails and toenails were involved, this typically occurred synchronously. Although there were cases with all toenails and fingernails involved (16.1%), we did not encounter any instances involving 13 to 19 nails. The nail changes mainly presented as onychomadesis. Spontaneous recovery without special treatment was the course for all patients. No relapse or new nail involvement was identified. CONCLUSIONS Nail change associated with HFMD usually occurs within 1 to 2 months after onset, mainly presents as onychomadesis, and is a self-limited process. Possible mechanisms are discussed.
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Affiliation(s)
- Dong-Ling Long
- Department of Dermatology, Fourth General Hospital of Nanhai, Foshan, China
| | - Shi-Yuan Zhu
- Department of Dermatology, Fourth General Hospital of Nanhai, Foshan, China
| | - Cai-Zi Li
- Department of Public Health, Fourth General Hospital of Nanhai, Foshan, China
| | - Cui-Yan Chen
- Department of Public Health, Fourth General Hospital of Nanhai, Foshan, China
| | - Wan-Tao Du
- Department of Public Health, Fourth General Hospital of Nanhai, Foshan, China
| | - Xi Wang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
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Marshall DM, Hansen JD, Lazio MP. Images in emergency medicine. Young Boy With Shedding Nails. Onychomadesis. Ann Emerg Med 2015; 66:584-618. [PMID: 26590738 DOI: 10.1016/j.annemergmed.2015.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- David M Marshall
- Madison Emergency Physicians, Department of Emergency Medicine, St. Clare Hospital, Baraboo, WI; School of Education, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI
| | - Joseph D Hansen
- Madison Emergency Physicians, Department of Emergency Medicine, St. Clare Hospital, Baraboo, WI; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Matthew P Lazio
- Madison Emergency Physicians, Department of Emergency Medicine, St. Clare Hospital, Baraboo, WI; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Bian L, Wang Y, Yao X, Mao Q, Xu M, Liang Z. Coxsackievirus A6: a new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide. Expert Rev Anti Infect Ther 2015; 13:1061-71. [DOI: 10.1586/14787210.2015.1058156] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Outbreak of hand, foot and mouth disease with onychomadesis caused by Coxsackie virus A16 in Granada. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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12
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Apalla Z, Sotiriou E, Pikou O, Lefaki I, Lallas A, Lazaridou E, Ioannides D. Onychomadesis after hand-foot-and-mouth disease outbreak in northern Greece: case series and brief review of the literature. Int J Dermatol 2015; 54:1039-44. [PMID: 25772385 DOI: 10.1111/ijd.12592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis was described as a late complication of hand-foot-and-mouth disease (HFMD). Onychomadesis outbreaks following HFMD have been reported in many countries worldwide. AIM To present a case series of onychomadesis in children, following HFMD outbreak in Northern Greece, and review literature data. METHODS Children with evident onychomadesis attending the outpatient clinic between November 2012 and January 2013 were included in the study. A questionnaire including demographic personal and family history information of the children was completed by the parents. Patients were clinically examined, and their pediatric and dermatological records were studied to confirm precedent HFMD. Direct microscopic examination and cultures for fungi were performed. Exposure of participants to coxsackievirus, based on serology testing during infection, was also recorded. RESULTS Sixty-eight children with onychomadesis were included. The mean number of affected nails was 8.82. Fingernails were more often involved. Previous clinical diagnosis of HFMD was confirmed in 67/68 cases. The mean time from HFMD diagnosis to onychomadesis development was 39.6 days (range: 28-56 days, STD: 7.33). Direct microscopic examination, as well as cultures for fungal species, was negative for the whole sample size. All the nail changes were transient with spontaneous regrowth after 1-4 months. CONCLUSION Our data indicate that onychomadesis outbreak in the region of Thessaloniki during fall-winter 2012-13 was highly related to the outbreak of HFMD. Our study reinforces existing evidence for the association between onychomadesis and HFMD.
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Affiliation(s)
- Zoe Apalla
- State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Eleni Sotiriou
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Pikou
- State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Ioanna Lefaki
- State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Aimilios Lallas
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Elizabeth Lazaridou
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Demetris Ioannides
- First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hardin J, Haber R. Onychomadesis: literature review. Br J Dermatol 2015; 172:592-6. [DOI: 10.1111/bjd.13339] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 12/29/2022]
Affiliation(s)
- J. Hardin
- Division of Dermatology; Richmond Road Diagnostic and Treatment Centre; University of Calgary; 1820 Richmond Road SW Calgary AB T2T5C7 Canada
| | - R.M. Haber
- Division of Dermatology; Richmond Road Diagnostic and Treatment Centre; University of Calgary; 1820 Richmond Road SW Calgary AB T2T5C7 Canada
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Navarro Moreno E, Almagro López D, Jaldo Jiménez R, Del Moral Campaña MC, Árbol Fernández G, Pérez Ruiz M, Almagro Nievas D. [Outbreak of hand, foot and mouth disease with onychomadesis caused by Coxsackie virus A16 in Granada]. An Pediatr (Barc) 2014; 82:235-41. [PMID: 25027620 DOI: 10.1016/j.anpedi.2014.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/04/2014] [Accepted: 05/22/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Due to the significant increase in the number of cases of hand, foot and mouth disease (HFMD) among pre-school children population during late 2011 and early 2012. A study has been proposed with the aim of describing the HFMD outbreak and analyzing the risk factors associated with suffering onychomadesis. PATIENTS AND METHODS A descriptive and analytical case-control study was designed. The study population was 376 children between 6 and 36 months old, living in the Basic Health Catchment area of Peligros (Granada). The study inclued an epidemiological survey of 28 cases and paired controls in order to collect data on the time, person and place, and implementing preventive actions and family health education. Finally a microbiological viral study of stool samples was made. RESULTS There were 64% of girls with average age 20.8 months. The clinical signs fornd were, fever (75%), vesicular palmar eruption (71%), plantar eruption (68%), erosive stomatitis (64%), and nail loss (46%). The risk of getting sick was 14 times greater for those children attending a childcare centre and had contact with sick cases (OR 13.8; 95% CI; 3.79-50.18). The average time since onset of symptoms and onychomadesis was 52 days, and its appearance was linked to the presence of ulcers in mouth (P=.006). Five samples were positive to enteroviruses Coxsackie A16. CONCLUSION There was an outbreak of HFMD detected by pediatricians and families. The cases presented with marked clinical symptoms, and the nail loss (onychomadesis) generated a social alarm. The cause of the outbreak was an enterovirus Coxsackie A16 transmitted among sick cases and through childcare centres.
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Affiliation(s)
- E Navarro Moreno
- Unidad de Gestión Clínica (UGC) Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen de las Nieves, Granada, España
| | - D Almagro López
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, España.
| | - R Jaldo Jiménez
- UGC de Peligros, Distrito Sanitario Granada-Metropolitano, Granada, España
| | - M C Del Moral Campaña
- UGC Medicina Preventiva, Vigilancia y Promoción de la Salud, Distrito Sanitario Granada-Metropolitano, Granada, España
| | - G Árbol Fernández
- UGC de Peligros, Distrito Sanitario Granada-Metropolitano, Granada, España
| | - M Pérez Ruiz
- UGC de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - D Almagro Nievas
- Unidad de Gestión Clínica (UGC) Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen de las Nieves, Granada, España
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Shin JY, Cho BK, Park HJ. A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines. Ann Dermatol 2014; 26:280-3. [PMID: 24882996 PMCID: PMC4037694 DOI: 10.5021/ad.2014.26.2.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/06/2013] [Accepted: 05/21/2013] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ji Yeon Shin
- Department of Dermatology, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Baik Kee Cho
- Department of Dermatology, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Abramovici G, Keoprasom N, Winslow C, Tosti A. Onycholysis and subungual haemorrhages in a patient with hand, foot and mouth disease. Br J Dermatol 2014; 170:748-9. [DOI: 10.1111/bjd.12689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G. Abramovici
- Department of Dermatology; Northwestern University; Chicago IL U.S.A
| | - N. Keoprasom
- Department of Dermatology; Bangkok Hospital; Bangkok Thailand
| | - C.Y. Winslow
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL U.S.A
| | - A. Tosti
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL U.S.A
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Feder HM, Bennett N, Modlin JF. Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6. THE LANCET. INFECTIOUS DISEASES 2013; 14:83-86. [PMID: 24287184 DOI: 10.1016/s1473-3099(13)70264-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A previously well infant aged 9 months presented with an acute, self-limiting illness characterised by high fever and a papular eruption that started on the face. Although fever subsided within 3 days, the rash worsened and extended over the whole body, with some papules evolving into vesiculobullous lesions. The infant had been exposed to children with a similar illness 1 week before onset. PCR of vesicular swabs and stool samples taken on day 6 of illness showed Coxsackie virus A6. The illness resolved within 10 days of onset, although onychomadesis was seen on both big toes at follow-up 5 weeks later. Our case exemplifies the severe, atypical cases of hand, foot, and mouth disease that have been reported worldwide since 2008, and in the USA since the 2011. Atypical hand, foot, and mouth disease is caused by a new lineage of Coxsackie virus A6 and is characterised by high fever and vesiculobullous eruptions on the calves and backs of the hands. Infants with eczema might be predisposed to severe disease.
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Affiliation(s)
- Henry M Feder
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Family Medicine, Connecticut Children's Medical Center, Hartford, CT, USA; University of Connecticut Health Center, Farmington, CT, USA.
| | - Nicholas Bennett
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - John F Modlin
- Department of Pediatrics and Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Cabrerizo M, Tarragó D, Muñoz-Almagro C, Del Amo E, Domínguez-Gil M, Eiros JM, López-Miragaya I, Pérez C, Reina J, Otero A, González I, Echevarría JE, Trallero G. Molecular epidemiology of enterovirus 71, coxsackievirus A16 and A6 associated with hand, foot and mouth disease in Spain. Clin Microbiol Infect 2013; 20:O150-6. [PMID: 24033818 DOI: 10.1111/1469-0691.12361] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/16/2013] [Accepted: 08/10/2013] [Indexed: 11/27/2022]
Abstract
Hand, foot and mouth disease (HFMD) is a childhood illness frequently caused by genotypes belonging to the enterovirus A species, including coxsackievirus (CV)-A16 and enterovirus (EV)-71. Between 2010 and 2012, several outbreaks and sporadic cases of HFMD occurred in different regions of Spain. The objective of the present study was to describe the enterovirus epidemiology associated with HFMD in the country. A total of 80 patients with HFMD or atypical rash were included. Detection and typing of the enteroviruses were performed directly in clinical samples using molecular methods. Enteroviruses were detected in 53 of the patients (66%). CV-A6 was the most frequent genotype, followed by CV-A16 and EV-71, but other minority types were also identified. Interestingly, during almost all of 2010, CV-A16 was the only causative agent of HFMD but by the end of the year and during 2011, CV-A6 became predominant, while CV-A16 was not detected. In 2012, however, both CV-A6 and CV-A16 circulated. EV-71 was associated with HFMD symptoms only in three cases during 2012. All Spanish CV-A6 sequences segregated into one major genetic cluster together with other European and Asian strains isolated between 2008 and 2011, most forming a particular clade. Spanish EV-71 strains belonged to subgenogroup C2, as did most of the European sequences circulated. In conclusion, the recent increase of HFMD cases in Spain and other European countries has been due to a larger incidence of circulating species A enteroviruses, mainly CV-A6 and CV-A16, and the emergence of new genetic variants of these viruses.
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Affiliation(s)
- M Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Kaminska K, Martinetti G, Lucchini R, Kaya G, Mainetti C. Coxsackievirus A6 and Hand, Foot and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review. Case Rep Dermatol 2013; 5:203-9. [PMID: 24019771 PMCID: PMC3764954 DOI: 10.1159/000354533] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hand, foot and mouth disease (HFMD) is a highly contagious viral infection characterized by typical maculopapular or vesicular eruptions on the hands and feet and in the oral cavity. It affects predominantly children and/or immunocompromised adults. It usually follows a benign and self-limiting course. However, HFMD cases with severe or lethal complications such as encephalitis, meningitis, pulmonary edema and myocarditis have also been reported, mostly in children, but also in adults. High infectivity of HFMD has contributed to several large outbreaks of this disease in recent decades in East and Southeast Asia, the United States and Finland. The most common pathogens were Coxsackievirus A16, Enterovirus 71 and, recently, also Coxsackieviruses A6 and A10. Differences in the course of HFMD have been observed, depending on the virus type. Recently, many cases of atypical HFMD have been described in the literature with unusual morphology and/or localization of skin lesions. Atypical HFMD manifestations including vesiculobullous exanthema, often on the trunk or extremities, and perioral zone involvement were often caused by Coxsackievirus A6 infections. We present 3 cases of familial transmission of HFMD caused by Coxsackievirus A6 with some atypical features, benign course and complete recovery among immunocompetent adults.
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Affiliation(s)
- Karolina Kaminska
- Department of Dermatology, Regional Hospital of Bellinzona, Bellinzona, Geneva, Switzerland
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21
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Mathes EF, Oza V, Frieden IJ, Cordoro KM, Yagi S, Howard R, Kristal L, Ginocchio CC, Schaffer J, Maguiness S, Bayliss S, Lara-Corrales I, Garcia-Romero MT, Kelly D, Salas M, Oberste MS, Nix WA, Glaser C, Antaya R. "Eczema coxsackium" and unusual cutaneous findings in an enterovirus outbreak. Pediatrics 2013; 132:e149-57. [PMID: 23776120 PMCID: PMC4074616 DOI: 10.1542/peds.2012-3175] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)-associated North American enterovirus outbreak of 2011-2012. METHODS We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS Eighty patients were included in this study (median age 1.5 years, range 4 months-16 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed "eczema coxsackium." Other morphologies included Gianotti-Crosti-like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.
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Affiliation(s)
- Erin F. Mathes
- Departments of Dermatology, and,Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Ilona J. Frieden
- Departments of Dermatology, and,Pediatrics, University of California, San Francisco, San Francisco, California
| | - Kelly M. Cordoro
- Departments of Dermatology, and,Pediatrics, University of California, San Francisco, San Francisco, California
| | - Shigeo Yagi
- State of California, Department of Public Health, Richmond, California
| | | | - Leonard Kristal
- Department of Dermatology, Stony Brook University, Stony Brook, New York
| | - Christine C. Ginocchio
- Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System Laboratories, Lake Success, New York
| | - Julie Schaffer
- Departments of Dermatology, and,Pediatrics, New York University School of Medicine, New York, New York
| | - Sheilagh Maguiness
- Pediatric Dermatology, Children’s Hospital Boston, Boston, Massachusetts
| | - Susan Bayliss
- Divisions of Dermatology, Pediatrics and Internal Medicine, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Irene Lara-Corrales
- Dept of Pediatrics, Division of Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Dan Kelly
- Pediatrics Private Practice, San Francisco, California
| | - Maria Salas
- State of California, Department of Public Health, Richmond, California
| | - M. Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - W. Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Carol Glaser
- State of California, Department of Public Health, Richmond, California
| | - Richard Antaya
- Dermatology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut
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Affiliation(s)
- Federica Scarfì
- Division of Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy
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Shah KN, Rubin AI. Nail disorders as signs of pediatric systemic disease. Curr Probl Pediatr Adolesc Health Care 2012; 42:204-11. [PMID: 22884027 DOI: 10.1016/j.cppeds.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
Herein, we describe some of the more common changes in the nail unit that can be seen in systemic diseases in children. Changes that can be seen are not limited to those discussed in the following pages. The presence of changes on multiple nails is suggestive of a systemic cause in an ill child. However, multiple nails can also be affected in primary inflammatory disorders and infections of the nail unit. When evaluating a pediatric patient with a nail disorder, it is important to perform a complete physical examination of the skin and oral mucosa, as other clues to the diagnosis of the nail problem may be found. A comprehensive family history is also important to uncover possible syndromic associations with nail disease or diseases that can manifest with nail changes.
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Affiliation(s)
- Kara N Shah
- Division of Pediatric Dermatology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Bracho MA, González-Candelas F, Valero A, Córdoba J, Salazar A. Enterovirus co-infections and onychomadesis after hand, foot, and mouth disease, Spain, 2008. Emerg Infect Dis 2012; 17:2223-31. [PMID: 22172227 PMCID: PMC3311182 DOI: 10.3201/eid1712.110395] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mixed infection of enteroviruses may explain the rare complication of nail shedding. Onychomadesis after HFMD Hand, foot, and mouth disease (HFMD), a common disease caused by enteroviruses (EVs), usually affects children. Clustered and sporadic HFMD cases, followed by onychomadesis (nail shedding), occurred during summer and fall 2008 in Valencia, Spain. Fecal samples from onychomadesis patients, who did or did not have previous HFMD, and from healthy children exposed to onychomadesis patients tested positive for EV. The complete viral protein 1 capsid gene sequence was obtained for typing and phylogenetic analysis. Two EV serotypes, coxsackievirus A10 and coxsackievirus B1 (CVB1), were mainly detected as a monoinfection or co-infection in a childcare center where an onychomadesis outbreak occurred. On the basis of our results, and detection of CVB1 in 2 other contemporary onychomadesis outbreaks in childcare centers in Spain, we propose that mixed infection of an EV serotype that causes HFMD, plus the serotype CVB1, could explain the emergence after HFMD of onychomadesis, a rare and late complication.
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Affiliation(s)
- Maria A Bracho
- Centro Superior de Investigación en Salud Pública, Valencia, Spain.
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Bettoli V, Zauli S, Toni G, Virgili A. Onychomadesis following hand, foot, and mouth disease: a case report from Italy and review of the literature. Int J Dermatol 2012; 52:728-30. [PMID: 22417170 DOI: 10.1111/j.1365-4632.2011.05287.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vincenzo Bettoli
- Dermatology Section, Department of Clinical and Experimental Medicine, Hospital Sant'Anna, University of Ferrara, Italy
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26
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Hoy NY, Leung AKC, Metelitsa AI, Adams S. New concepts in median nail dystrophy, onychomycosis, and hand, foot, and mouth disease nail pathology. ISRN DERMATOLOGY 2012; 2012:680163. [PMID: 22462009 PMCID: PMC3302018 DOI: 10.5402/2012/680163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/04/2011] [Indexed: 11/23/2022]
Abstract
Nails are underutilized as diagnostic tools, despite being involved in many dermatologic conditions. This paper explores new concepts in the treatment of median nail dystrophy (MND), onychomycosis, and the nail pathology of hand, foot, and mouth disease (HFMD). A Pubmed database literature search was conducted for MND treatment, onychomycosis treatment, and HFMD nail pathology. Only papers published after January 2008 were reviewed. The results showed that 0.1% tacrolimus ointment can be an effective treatment for MND. Early studies on laser therapy indicate that it is a safe and efficacious treatment option for onychomycosis, compared to conventional oral antifungal agents. Vicks VapoRub (The Proctor & Gamble Company, Cincinnati, OH) is effective against onychomycosis and is a reasonable option in patients who choose to forgo conventional treatments. Lastly, there is evidence to support a correlation between HFMD and onychomadesis.
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Affiliation(s)
- Nathan Y Hoy
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R7
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27
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Wei SH, Huang YP, Liu MC, Tsou TP, Lin HC, Lin TL, Tsai CY, Chao YN, Chang LY, Hsu CM. An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis 2011; 11:346. [PMID: 22168544 PMCID: PMC3297538 DOI: 10.1186/1471-2334-11-346] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background In 2010, an outbreak of coxsackievirus A6 (CA6) hand, foot and mouth disease (HFMD) occurred in Taiwan and some patients presented with onychomadesis and desquamation following HFMD. Therefore, we performed an epidemiological and molecular investigation to elucidate the characteristics of this outbreak. Methods Patients who had HFMD with positive enterovirus isolation results were enrolled. We performed a telephone interview with enrolled patients or their caregivers to collect information concerning symptoms, treatments, the presence of desquamation, and the presence of nail abnormalities. The serotypes of the enterovirus isolates were determined using indirect immunofluorescence assays. The VP1 gene was sequenced and the phylogenetic tree for the current CA6 strains in 2010, 52 previous CA6 strains isolated in Taiwan from 1998 through 2009, along with 8 reference sequences from other countries was constructed using the neighbor-joining command in MEGA software. Results Of the 130 patients with laboratory-confirmed CA6 infection, some patients with CA6 infection also had eruptions around the perioral area (28, 22%), the trunk and/or the neck (39, 30%) and generalized skin eruptions (6, 5%) in addition to the typical presentation of skin eruptions on the hands, feet, and mouths. Sixty-six (51%) CA6 patients experienced desquamation of palms and soles after the infection episode and 48 (37%) CA6 patients developed onychomadesis, which only occurred in 7 (5%) of 145 cases with non-CA6 enterovirus infection (p < 0.001). The sequences of viral protein 1 of CA6 in 2010 differ from those found in Taiwan before 2010, but are similar to those found in patients in Finland in 2008. Conclusions HFMD patients with CA6 infection experienced symptoms targeting a broader spectrum of skin sites and more profound tissue destruction, i.e., desquamation and nail abnormalities.
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Affiliation(s)
- Sung-Hsi Wei
- Taiwan Centers for Disease Control, Taipei, Taiwan
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Abstract
Nail disorders in children can be divided into seven categories. The first is physiologic alterations, which every physician should be aware of in order to reassure parents. These usually disappear with age and do not require any treatment. Among congenital and inherited conditions, the nail-patella syndrome, with its pathognomonic triangular lunula, should not be missed as recognition of the disease allows early diagnosis of associated pathologies. The most common infection is the periungual wart, whose treatment is delicate. Herpetic whitlow should be distinguished from bacterial whitlow as their therapeutic approaches differ. Dermatologic diseases encompass eczema, psoriasis, lichen planus, lichen striatus, trachyonychia, and parakeratosis pustulosa. Lichen planus, when it presents as in adults, is important to recognize because, if not treated, it may lead to permanent nail loss. Systemic or iatrogenic nail alterations may be severe but are usually not the first clue to the diagnosis. Beau lines on several fingernails are very common in children after temperature crest. Tumors are rare in children. Radiographic examination allows confirmation of the diagnosis of subungual exostosis. Other cases should undergo biopsy. Single-digit longitudinal melanonychia in children is mostly due to nevi. Its management should be tailored on a case-by-case basis. Acute trauma should never be underestimated in children and hand surgeons should be involved if necessary. Onychophagia and onychotillomania are responsible for chronic trauma.
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Affiliation(s)
- Bertrand Richert
- Department of Dermatology, University Hospital of Liège, Liège, Belgium.
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Davia JL, Bel PH, Ninet VZ, Bracho MA, González-Candelas F, Salazar A, Gobernado M, Bosch IF. Onychomadesis outbreak in Valencia, Spain associated with hand, foot, and mouth disease caused by enteroviruses. Pediatr Dermatol 2011; 28:1-5. [PMID: 20553401 DOI: 10.1111/j.1525-1470.2010.01161.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This report evaluates the June 2008 onychomadesis outbreak in Valencia, Spain. The study sample consisted of 221 onychomadesis cases and 77 nonaffected individuals who lived close to those affected. We collected data on dietary variables, hygiene products, and individual pathological histories. Feces and blood specimens were collected from 44 cases and 24 controls to evaluate exposure to infectious agents. Pathological background data revealed a high frequency (61%) of hand, foot, and mouth disease among the onychomadesis cases. Coxsackievirus A10 was the most commonly detected enterovirus in both case and control groups (49%). Other enteroviruses such as coxsackieviruses A5, A6, A16, B1, and B3; echoviruses 3, 4, and 9; and enterovirus 71 were present in low frequencies in the case and control groups (3-9%). The 2008 onychomadesis outbreak in the metropolitan area of Valencia was associated with an outbreak of hand, foot, and mouth disease primarily caused by coxsackievirus A10.
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Affiliation(s)
- Javier López Davia
- Dermatology Service, University General Hospital Consortium, Valencia, Spain.
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Abstract
Few reports exist regarding the association between onychomadesis and an enterovirus infection presenting clinically as hand, foot, and mouth disease (HFMD). In February 2009, an outbreak of HFMD occurred in a Spanish nursery school, followed by onychomadesis 36-69 days later. Twelve of 17 children with HFMD developed nail shedding; enterovirus was detected in stool samples from eight (47%) of the 17. However, in only three of the children could an enterovirus serotype coxsackievirus B1 be identified. The epidemiological results of this study confirm onychomadesis as a complication in HFMD. In future outbreaks, molecular characterization of enterovirus from appropriate clinical samples should be studied.
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Osterback R, Vuorinen T, Linna M, Susi P, Hyypiä T, Waris M. Coxsackievirus A6 and hand, foot, and mouth disease, Finland. Emerg Infect Dis 2010; 15:1485-8. [PMID: 19788821 PMCID: PMC2819858 DOI: 10.3201/eid1509.090438] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland. We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent. CVA6 infections may be emerging as a new and major cause of epidemic HFMD.
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Venugopal SS, Murrell DF. Seasonal onychomadesis in an elderly gentleman. Dermatol Reports 2009; 1:e3. [PMID: 25386235 PMCID: PMC4211465 DOI: 10.4081/dr.2009.e3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/06/2009] [Accepted: 12/09/2009] [Indexed: 11/29/2022] Open
Abstract
A 79-year-old man with a history of dementia and hypertension initially presented with a ten year history of Beau's lines and seasonal nail shedding of his fingernails only. He denied any exposure to heavy metals, unusual activities or food. He stated that the seasonal nail shedding had been occurring for the last 5–10 years. On examination, six out of ten fingernails had been affected. He had significant toenail dystrophy. Fungal cultures and PAS staining of the toenails were negative. Routine serum biochemistry and haematology results were normal. Serum arsenic, cadmium and lead levels were also normal. Vitamin B12, zinc, folate, iron studies, thyroid function studies and homocysteine levels were also normal. Rheumatoid factor and anti-cyclic citrullinated peptide antibody antibodies were negative. Bilateral hand X-ray showed osteoarthritic change and did not show any features of psoriatic arthropathy. We discuss the case of a 79-year-old man with seasonal nail shedding, curiously affecting his fingernails only.
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Affiliation(s)
- Supriya S Venugopal
- Department of Dermatology, St George Hospital, Sydney; ; University of NSW Sydney
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Sydney; ; University of NSW Sydney
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Redondo Granado MJ, Torres Hinojal MC, Izquierdo López B. [Post viral onychomadesis outbreak in Valladolid]. An Pediatr (Barc) 2009; 71:436-9. [PMID: 19819202 DOI: 10.1016/j.anpedi.2009.07.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 07/14/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION An onychomadesis outbreak associated with hand-foot-mouth disease (HFMD) was notified in winter 2008 in Valencia, Spain, with more than 200 people affected, the majority children. Even though this association has already described, this was the first outbreak known in the world. Sixteen cases of post-viral onychomadesis post viral in Valladolid are presented MATERIAL AND METHODS Between November 2008 and February 2009, 15 children aged between 18 months and 3 years, and one mother, presented with onychomadesis in Primary Care Centres in Valladolid. RESULTS HFMD was diagnosed in a single month in 11 patients who attended two nurseries. The others attended others nurseries of Valladolid area. Nine children (60%) had the clinical diagnosis of HFMD 3 to 12 weeks before (mean: 6 weeks), six with fever. The nail changes were usually temporary with spontaneous normal re-growth in 1 to 4 months. CONCLUSIONS The clinical and epidemiological characteristics of this report were similar to the Valencia outbreak: age, geographic clustering, acral eruption prior, etc. Perhaps the diagnosis is underestimated due to ignorance of the disease and the long interval between the acute viral process and nail shedding.
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