Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease

Sam Hassan

doi:doi:10.11648/j.ajp.20190503.11

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Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease

Sam Hassan

Published in American Journal of Pediatrics (Volume 5, Issue 3)

Received: 6 May 2019 Accepted: 10 June 2019 Published: 26 June 2019

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Abstract

Onychomadesis or onycholysis is a newly recognized complication in the course of viral infections particularly the Hand Foot Mouth Disease (HFMD) in children and adults. Onychomadesis is characterized by proximal separation of the nail plate from the nail matrix due to temporary cessation of growth of the nail matrix. The etiology of onychomadesis is including infections, trauma, medications side effects, systemic diseases and idiopathic. The association of the HFMD and the onychomadesis first reported in the year 2000. Since then, few studies and case reports published illustrating the relationship of the HFMD and the resultant onychomadesis 4 to 8 weeks after the resolution of the HFMD. HFMD is a relatively common viral infection, especially in children of preschool age. It is usually presented with characteristic eruption on hands, feet and mouth. Out breaks may happen in nurseries and schools. HFMD usually caused by enteroviruses, most commonly, Coxsackie virus A (CVA) and enterovirus 71 (EV71). It is usually self-limiting disease however; serious neurological complications have been reported with EV71. The enteroviruses that cause HFMD and nail changes may cause herpangina which is unlike the HFMD, usually characterized by mouth spots on the soft palate without the skin manifestations, however onychomadesis was not reported before with herpangina. This case presented with no HFMD eruption but small red spots on the soft palate consistent with herpangina. Enterovirus was isolated from throat swab and the onychomadesis occurred 1 month after the resolution of the soft palate spots. It is the first case report about nail changes occurring after herpangina presentation. It is therefore important that in patients presented with onychomadesis to consider the review of the patient's history not only for HFMD but herpangina and possible other EV infections, 8 weeks before the nail changes, to avoid unnecessary referrals, concerns and over investigations. The exact mechanism of the nail changes is not yet known and a review of theories behind the nail damage will be considered in this report.

Published in	American Journal of Pediatrics (Volume 5, Issue 3)
DOI	10.11648/j.ajp.20190503.11
Page(s)	78-81
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Hand Foot Mouth Disease, Herpangina, Enetrovirus Infection, Nails, Onychomadesis

References

[1]	Clementz GC, Mancini AJ. Nail matrix arrest following hand-foot-mouth disease: a report of five children. Pediatr Dermatol. 2000;17:7-11.
[2]	Deeb M, Beach RA, Kim S. Onychomadesis following hand, foot, and mouth disease in a pregnant woman: A case report. SAGE Open Med Case Rep. 2019; 7:2050313X19845202. doi:10.1177/2050313X19845202
[3]	Giordano L MC, de la Fuente L A, Lorca J MB, Kramer H D. Onychomadesis secondary to hand-foot-mouth disease: a frequent manifestation and cause of concern for parents. Rev Chil Pediatr. 2018; 89 (3):380-383. doi: 10.4067/S0370-41062018005000203. Spanish.
[4]	Kuehnel NA, Thach S, Thomas DG. Onychomadesis as a Late Complication of Hand-Foot-Mouth Disease: A Case Series Shedding Light on Nail Shedding. Pediatr Emerg Care. 2017; 33 (11):e122-e123. doi: 10.1097/PEC.0000000000001292.
[5]	Hand Foot and Mouth Disease (HFMD); Causes and transmission; Centre for Disease Control and Prevention; https://www.cdc.gov/hand-foot-mouth/about/transmission.html; page reviewed Feb 2019.
[6]	Shin YJi, Cho BK, and Park HJ. A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines. Ann Dermatol. 2014; 26: 280–283. doi: 10.5021/ad.2014.26.2.280
[7]	Yao X, Bian LL, Lu WW, Li JX, Mao QY, Wang YP, Gao F, Wu X, Ye Q, Li XL, Zhu FC, Liang Z. Epidemiological and etiological characteristics of herpangina and hand foot mouth diseases in Jiangsu, China, 2013-2014. Hum Vaccin Immunother. 2017; 13 (4):823-830.
[8]	Corsino CB, Linklater DR. Herpangina. [Updated 2019 Apr 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507792/
[9]	B'Krong NTTC, Minh NNQ, Qui PT, Chau TTH, Nghia HDT, Do LAH, Nhung NN, Van Vinh Chau N, Thwaites G, Van Tan L, van Doorn HR, Thanh TT. Enterovirus serotypes in patients with central nervous system and respiratory infections in Viet Nam 1997-2010. Virol. J. 2018;15 (1):69.
[10]	Puenpa J, Mauleekoonphairoj J, Linsuwanon P, et al. Prevalence and characterization of enterovirus infections among pediatric patients with hand foot mouth disease, herpangina and influenza like illness in Thailand, 2012. PLoS One. 2014;9 (6):e98888. doi: 10.1371/journal.pone.0098888
[11]	Boyarchuk, O., Volyanska, L., and Dyvonyak, O. Nail changes in case of enteroviral infections in western ukraine: a report of 34 cases. 2017; International Journal of Medicine and Medical Research, 2: 2413; https://doi.org/10.11603/ijmmr.
[12]	Nguyen NT, Pham HV, Hoang CQ, et al. Epidemiological and clinical characteristics of children who died from hand, foot and mouth disease in Vietnam, 2011. BMC Infect Dis. 2014;18 (14):341. doi: 10.1186/1471-2334-14-341
[13]	Chen YF, Hu L, Xu F, Liu CJ, Li J. A case report of a teenager with severe hand, foot, and mouth disease with brainstem encephalitis caused by enterovirus 71. 2019; BMC Pediatr. 9 (1):59. doi:10.1186/s12887-019-1428-4
[14]	Beau JHS. Note sur certains caracteres de semeilogie retrospective presentes par les ongles. 1846. Arch Gen Med. 11:447–58.
[15]	Venugopal SS, Murrell DF. Seasonal onychomadesis in an elderly gentleman. 2010. Dermatol Reports. 1 (1):e3. doi:10.4081/dr.2009.e3

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APA Style

Sam Hassan. (2019). Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease. American Journal of Pediatrics, 5(3), 78-81. https://doi.org/10.11648/j.ajp.20190503.11

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ACS Style

Sam Hassan. Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease. Am. J. Pediatr. 2019, 5(3), 78-81. doi: 10.11648/j.ajp.20190503.11

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AMA Style

Sam Hassan. Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease. Am J Pediatr. 2019;5(3):78-81. doi: 10.11648/j.ajp.20190503.11

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@article{10.11648/j.ajp.20190503.11,
  author = {Sam Hassan},
  title = {Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {3},
  pages = {78-81},
  doi = {10.11648/j.ajp.20190503.11},
  url = {https://doi.org/10.11648/j.ajp.20190503.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.11},
  abstract = {Onychomadesis or onycholysis is a newly recognized complication in the course of viral infections particularly the Hand Foot Mouth Disease (HFMD) in children and adults. Onychomadesis is characterized by proximal separation of the nail plate from the nail matrix due to temporary cessation of growth of the nail matrix. The etiology of onychomadesis is including infections, trauma, medications side effects, systemic diseases and idiopathic. The association of the HFMD and the onychomadesis first reported in the year 2000. Since then, few studies and case reports published illustrating the relationship of the HFMD and the resultant onychomadesis 4 to 8 weeks after the resolution of the HFMD. HFMD is a relatively common viral infection, especially in children of preschool age. It is usually presented with characteristic eruption on hands, feet and mouth. Out breaks may happen in nurseries and schools. HFMD usually caused by enteroviruses, most commonly, Coxsackie virus A (CVA) and enterovirus 71 (EV71). It is usually self-limiting disease however; serious neurological complications have been reported with EV71. The enteroviruses that cause HFMD and nail changes may cause herpangina which is unlike the HFMD, usually characterized by mouth spots on the soft palate without the skin manifestations, however onychomadesis was not reported before with herpangina. This case presented with no HFMD eruption but small red spots on the soft palate consistent with herpangina. Enterovirus was isolated from throat swab and the onychomadesis occurred 1 month after the resolution of the soft palate spots. It is the first case report about nail changes occurring after herpangina presentation. It is therefore important that in patients presented with onychomadesis to consider the review of the patient's history not only for HFMD but herpangina and possible other EV infections, 8 weeks before the nail changes, to avoid unnecessary referrals, concerns and over investigations. The exact mechanism of the nail changes is not yet known and a review of theories behind the nail damage will be considered in this report.},
 year = {2019}
}

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TY - JOUR
T1 - Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease
AU - Sam Hassan
Y1 - 2019/06/26
PY - 2019
N1 - https://doi.org/10.11648/j.ajp.20190503.11
DO - 10.11648/j.ajp.20190503.11
T2 - American Journal of Pediatrics
JF - American Journal of Pediatrics
JO - American Journal of Pediatrics
SP - 78
EP - 81
PB - Science Publishing Group
SN - 2472-0909
UR - https://doi.org/10.11648/j.ajp.20190503.11
AB - Onychomadesis or onycholysis is a newly recognized complication in the course of viral infections particularly the Hand Foot Mouth Disease (HFMD) in children and adults. Onychomadesis is characterized by proximal separation of the nail plate from the nail matrix due to temporary cessation of growth of the nail matrix. The etiology of onychomadesis is including infections, trauma, medications side effects, systemic diseases and idiopathic. The association of the HFMD and the onychomadesis first reported in the year 2000. Since then, few studies and case reports published illustrating the relationship of the HFMD and the resultant onychomadesis 4 to 8 weeks after the resolution of the HFMD. HFMD is a relatively common viral infection, especially in children of preschool age. It is usually presented with characteristic eruption on hands, feet and mouth. Out breaks may happen in nurseries and schools. HFMD usually caused by enteroviruses, most commonly, Coxsackie virus A (CVA) and enterovirus 71 (EV71). It is usually self-limiting disease however; serious neurological complications have been reported with EV71. The enteroviruses that cause HFMD and nail changes may cause herpangina which is unlike the HFMD, usually characterized by mouth spots on the soft palate without the skin manifestations, however onychomadesis was not reported before with herpangina. This case presented with no HFMD eruption but small red spots on the soft palate consistent with herpangina. Enterovirus was isolated from throat swab and the onychomadesis occurred 1 month after the resolution of the soft palate spots. It is the first case report about nail changes occurring after herpangina presentation. It is therefore important that in patients presented with onychomadesis to consider the review of the patient's history not only for HFMD but herpangina and possible other EV infections, 8 weeks before the nail changes, to avoid unnecessary referrals, concerns and over investigations. The exact mechanism of the nail changes is not yet known and a review of theories behind the nail damage will be considered in this report.
VL - 5
IS - 3
ER -

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Author Information

Sam Hassan

Department of Paediatrics, Mediclinic City Hospital, Dubai Health Care City, Dubai

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APA Style

Sam Hassan. (2019). Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease. American Journal of Pediatrics, 5(3), 78-81. https://doi.org/10.11648/j.ajp.20190503.11

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ACS Style

Sam Hassan. Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease. Am. J. Pediatr. 2019, 5(3), 78-81. doi: 10.11648/j.ajp.20190503.11

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AMA Style

Sam Hassan. Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease. Am J Pediatr. 2019;5(3):78-81. doi: 10.11648/j.ajp.20190503.11

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@article{10.11648/j.ajp.20190503.11,
  author = {Sam Hassan},
  title = {Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {3},
  pages = {78-81},
  doi = {10.11648/j.ajp.20190503.11},
  url = {https://doi.org/10.11648/j.ajp.20190503.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.11},
  abstract = {Onychomadesis or onycholysis is a newly recognized complication in the course of viral infections particularly the Hand Foot Mouth Disease (HFMD) in children and adults. Onychomadesis is characterized by proximal separation of the nail plate from the nail matrix due to temporary cessation of growth of the nail matrix. The etiology of onychomadesis is including infections, trauma, medications side effects, systemic diseases and idiopathic. The association of the HFMD and the onychomadesis first reported in the year 2000. Since then, few studies and case reports published illustrating the relationship of the HFMD and the resultant onychomadesis 4 to 8 weeks after the resolution of the HFMD. HFMD is a relatively common viral infection, especially in children of preschool age. It is usually presented with characteristic eruption on hands, feet and mouth. Out breaks may happen in nurseries and schools. HFMD usually caused by enteroviruses, most commonly, Coxsackie virus A (CVA) and enterovirus 71 (EV71). It is usually self-limiting disease however; serious neurological complications have been reported with EV71. The enteroviruses that cause HFMD and nail changes may cause herpangina which is unlike the HFMD, usually characterized by mouth spots on the soft palate without the skin manifestations, however onychomadesis was not reported before with herpangina. This case presented with no HFMD eruption but small red spots on the soft palate consistent with herpangina. Enterovirus was isolated from throat swab and the onychomadesis occurred 1 month after the resolution of the soft palate spots. It is the first case report about nail changes occurring after herpangina presentation. It is therefore important that in patients presented with onychomadesis to consider the review of the patient's history not only for HFMD but herpangina and possible other EV infections, 8 weeks before the nail changes, to avoid unnecessary referrals, concerns and over investigations. The exact mechanism of the nail changes is not yet known and a review of theories behind the nail damage will be considered in this report.},
 year = {2019}
}

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