Why the study?
Atypical skin findings of hand-foot-mouth disease, often involving sites beyond palms and soles with polymorphic morphology, have been increasingly reported worldwide since 2008.
What are the clinical features and outcomes of pediatric hand-foot-mouth disease with atypical cutaneous manifestations?
What are the clinical features and outcomes of pediatric hand-foot-mouth disease with atypical cutaneous manifestations?
Atypical HFMD in children often presents with vesicles, papules, and bullae on the arms, legs, face, and trunk, frequently associated with CVA6, and awareness is needed to avoid misdiagnosis.
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Awareness of atypical HFMD prevents misdiagnosis in children; extends phenotypic characterization of CVA6 cases.
INTRODUCTION: 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.
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Starkey et al. (2023) studied this question.
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