Onychomadesis Following the Outbreak of Hand Foot Mouth Disease in Children: A Study from North India

Abstract

Background: Hand, foot and mouth disease (HFMD) is a common viral disease that usually inflicts children. It usually resolves without major complications in about 1-3 weeks, however; there are various reports of onychomadesis occurring as a late complication of hand-foot-and-mouth disease (HFMD). Aim: To study onychomadesis in children, following HFMD outbreak in Kashmir valley and review the available literature about same. Methods: Children presenting with onychomadesis between June 2015 to August 2015 were studied in this prospective study. The parents were questioned regarding the history of any preceding acral skin and/or oral vesicular rash preceding the nail changes. Children were clinically examined, and their pediatric and dermatological records were studied to confirm precedent HFMD. Only those cases with the preceding history or documentation of onychomadesis were included in the study. Results: Seventeen children with onychomadesis in 72 nails were included in the study. The mean number of affected nails was 4.23. Fingernails were more often involved (37/70). Preceding diagnosis of HFMD was clinically confirmed in all the cases. The mean time from HFMD diagnosis to onychomadesis development was 5.7 weeks (range: 3-10 weeks, SD: 1.89). Conclusion: Our data indicate that onychomadesis outbreak in the Kashmir valley during summer 2015 was highly related to the epidemic of HFMD. Our study reinforces existing evidence for the association between onychomadesis and HFMD.