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Atypical Cutaneous Findings of Hand–Foot–Mouth Disease in Children
TAKE-HOME MESSAGE
- This systematic review analyzed data from 85 studies comprising 1359 pediatric patients with hand–foot–mouth disease (HFMD). The most commonly reported morphologies included vesicles, papules, and bullae, whereas the less common morphologies included purpuric/petechial lesions, eczema herpeticum–like lesions, and Gianotti Crosti–like lesions. The patients' symptoms were resolved within a median of 10 days. Overall, 16% of all patients received treatment, commonly with acyclovir, intravenous antibiotics, and topical steroids.
- Patients with HFMD may present with diverse morphologies, emphasizing the importance of recognizing these variations to prevent misdiagnosis and unnecessary treatments.
abstract
This abstract is available on the publisher's site.
Access this abstract nowINTRODUCTION
Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology.
METHODS
A systematic review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations.
RESULTS
Eighty-five studies were included, representing 1359 cases with mean age 2.4 years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum-like (19%), purpuric/petechial (7%), and Gianotti Crosti-like (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10 days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2 weeks after symptoms, respectively.
CONCLUSION
Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.
Additional Info
Disclosure statements are available on the authors' profiles:
Atypical cutaneous findings of hand-foot-mouth disease in children: A systematic review
Pediatr Dermatol 2023 Oct 25;[EPub Ahead of Print], SY Starkey, K Mar, S Khaslavsky, D Seeburruth, B Khalid, D Virmani, JM Lam, I MukovozovFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Hand-foot-mouth disease (HDMD) is extremely common in children, and manifestations vary greatly. While infections with the causative enteroviruses are often localized and mild, widespread vesicles and bullae are seen increasingly in children with atopic dermatitis, often with seasonal predilection, due to coxsackievirus A6. This article highlights the atypical morphology of eczema coxsackium, the importance of recognizing this, and not overtreating as eczema herpeticum or bacterial infection. The arms, legs, and face are often involved with vesicles, and hospitalization may be required for supportive care and hydration. Symptoms often last for 10 days, and dermatologists see these children weeks after their infection for the common nail finding of onychomadesis. Of note, this nail finding may be more common in patients with atypical HFMD.