Onycholysis and subungual haemorrhages in a patient with hand, foot and mouth disease

Funding sources: none. Conflicts of interest: none declared. Dear Editor, We report here a new nail manifestation of hand, foot and mouth disease (HFMD). A 39‐year‐old woman was referred to the dermatology clinic for evaluation of extensive fingernail changes that had developed 1 week earlier. Two weeks prior to presentation, the patient had a fever and sore throat followed by a vesicular eruption on her hands, feet and oral mucosa. Her primary care physician diagnosed HFMD. Approximately 1 week after the initial vesicular eruption, the patient noted sloughing of the skin on her hands and feet, and rapid changes involving all 10 fingernails. Past medical history was unremarkable. Clinical examination revealed distal onycholysis of all 10 fingers and complete absence of the left fifth fingernail (Fig. 1). Scaly erythematous plaques with peripheral desquamation were noted on the palms and soles. On dermoscopic evaluation, the area of onycholysis had sharp proximal borders and included multiple splinter haemorrhages (Fig. 2). The patient was advised that her skin and nail findings were likely sequelae of her recent viral illness.