IDENTIFICATION of atypical cutaneous manifestations of hand, foot, and mouth disease (HFMD), such as atypical distribution of vesicles, which is associated with coxsackievirus A6 (CVA6), could improve patient care, suggests a new study. These atypical manifestations were first reported in 2008, and have increased worldwide; however, CVA6 has previously not attracted clinical attention, as affected children usually showed mild or no symptoms.
The systematic review included 85 studies with 1,359 atypical cases of HFMD. CVA6 was identified in 63% of cases, leading to reported morphologies of papules (49%), vesicles (53%), macules (20%), bullae (36%), erosions (14%), eczema herpeticum-like (19%), crust (6%), purpuric/petechial (7%), Gianotti Crosti-like (4%), and mucosal ulcers (4%). The vesicular lesions were most commonly found on the palms, soles, and oral mucosa, but in some cases, were spread as far as the dorsal hands and feet, legs, trunk, arms, and neck, with rare involvement of the oral mucosa. Authors noted that arms or legs were the most common atypical location of various cutaneous manifestations (47%), followed by the face (45%) and the trunk (27%).
In total, 74% of atypical cases reported fever as the most common symptom, while 18% experienced pharyngitis and 16% cough, results that are similar to classic HFMD. A further 21% of patients reported onychomadesis, and 4% experienced Beau’s lines. Samantha Starkey, University of British Columbia, Vancouver, Canada, and colleagues, stated that while these complications are consistent with typical HFMD, there is evidence that atypical HFMD cases have higher rates of nail changes.
They concluded: “HFMD should be considered in the differential diagnosis of patients with new-onset vesicles and erosions on eczematous areas, for acral purpura, and for a Gianotti-Crosti-like papulovesicular rash with prominent erosions.”
