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LETTER TO EDITOR
Year : 2015  |  Volume : 16  |  Issue : 4  |  Page : 264-265

Onychomadesis in a healthy child


Department of Pediatrics, Bangalore Baptist Hospital, Bengaluru, Karnataka, India

Date of Web Publication24-Sep-2015

Correspondence Address:
Rachel Ranitha Peterson
Department of Pediatrics, Bangalore Baptist Hospital, Bengaluru - 560 024, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.165668

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How to cite this article:
Peterson RR, Spurgeon R, Lakshmi K S, Rath S. Onychomadesis in a healthy child. Indian J Paediatr Dermatol 2015;16:264-5

How to cite this URL:
Peterson RR, Spurgeon R, Lakshmi K S, Rath S. Onychomadesis in a healthy child. Indian J Paediatr Dermatol [serial online] 2015 [cited 2020 Mar 29];16:264-5. Available from: http://www.ijpd.in/text.asp?2015/16/4/264/165668

Sir,

Hand, foot and mouth disease (HFMD) is a common viral illness affecting children, presenting with fever, malaise, vesicular lesions in the mouth and maculo-papular or vesicular lesions on the hands, feet and buttocks. The symptoms usually resolve without major complications in about 1-3 weeks. It is usually seen from July to October in India. Recently, HFMD has been reaching epidemic proportions with outbreaks being reported from various parts of India including Shimla, West Bengal and parts of southern and eastern India. [1],[2],[3] The causative organisms of HFMD are Coxsackie virus A 16, 4, 5, 6, 7, 9, 10 and 24, Coxsackie B virus 1, 2, 3, 4, 5, Enterovirus 71 and Echoviruses. [4] In a study conducted in southern and eastern India, Coxsackie virus A16 and A6 were identified as major causative organisms of HFMD. [2] Onychomadesis or nail shedding is a rare complication of HFMD, which can be a major cause of parental anxiety if the etiology cannot be explained. Reports of onychomadesis following HFMD are few from India and may have been missed out due to lack of awareness among clinicians.

A 2-year-old boy from Bangalore presented with HFMD and recovered 1-week after onset of illness with no complications. Six weeks later, he developed Beau's lines (transverse ridging of the nail plate) on all finger and toe nails and 10 days later the nails started falling off [Figure 1] and [Figure 2]. There was no history of preceding nail trauma, injury or drug intake. His height and weight were normal for age, and there was no other significant illness in the past. He was fully immunized and belonged to the higher socioeconomic group. There was spontaneous re-growth of the nails in a month.
Figure 1: Beau's lines on the ring and little finger, onychomadesis on the middle finger and new nail formation on the index finger

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Figure 2: Onychomadesis of the toe nails

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Onychomadesis is an acute noninflammatory condition affecting the nail matrix which results in spontaneous separation of the nail plate from the matrix starting at the proximal end. In healthy children, onychomadesis is a rare finding and can be a cause for anxiety in parents. Onychomadesis as a rare and late complication of HFMD was first described in the year 2000 in USA and later in Finland, Taiwan, Japan and Spain. [5],[6] Patients present with clinical manifestations ranging from Beau's lines due to slowing of nail matrix growth or onychomadesis due to complete arrest of nail matrix growth about 1-2 months after the initial symptoms of HFMD. This is usually followed by a spontaneous re-growth of nails in 1-4 months. Coxsackie virus A6, A10 and B1 have been commonly associated with onychomadesis following HFMD. The mechanism by which the nail matrix is affected in HFMD is unknown, but replication of the virus causing temporary damage to the nail matrix has been considered to be the most plausible explanation. [7] In an outbreak in Spain in 2008, infection with an Enterovirus serotype causing HFMD plus co infection with Coxsackie virus B1 has been hypothesized as a cause for onychomadesis. Genetic and environmental susceptibility, familial predisposition, history of previous HFMD, age <2 years have also been postulated as potential causes for onychomadesis. Our child had just completed 2 years and had no previous history of HFMD. His other two siblings had no history of prior HFMD or onychomadesis. Other causes of onychomadesis in children include trauma, poor nutrition, severe illness, auto immune diseases, drugs like sodium valproate and chemotherapeutic agents and idiopathic causes.

Clinicians should be aware of this rare but benign complication of HFMD, which resolves spontaneously without intervention. As onychomadesis is a late complication of HFMD, there would not be any evidence of HFMD at the time the child has onychomadesis. History suggestive of preceding HFMD, should be taken in any child who presents with onychomadesis. Parents should be counseled accordingly. Further large scale studies are needed in India to determine the incidence of onychomadesis following HFMD. The causative viruses behind this new complication of HFMD and the other predisposing factors for developing this complication in India also need to be studied.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Kashyap S, Verma GK. Hand-foot-mouth disease: Outbreak in Shimla. Indian Pediatr 2014;51:155.  Back to cited text no. 1
    
2.
Gopalkrishna V, Patil PR, Patil GP, Chitambar SD. Circulation of multiple Enterovirus serotypes causing hand, foot and mouth disease in India. J Med Microbiol 2012;61:420-5.  Back to cited text no. 2
    
3.
Sarma N, Sarkar A, Mukherjee A, Ghosh A, Dhar S, Malakar R. Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study. Indian J Dermatol 2009;54:26-30.  Back to cited text no. 3
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4.
Leung AK, editor. "Hand-foot-and-mouth disease." In: Common Problems in Ambulatory Pediatrics: Specific Clinical Problems. Vol. 1. New York, USA: Nova Science Publishers; 2011.  Back to cited text no. 4
    
5.
Clementz GC, Mancini AJ. Nail matrix arrest following hand-foot-mouth disease: A report of five children. Pediatr Dermatol 2000;17:7-11.  Back to cited text no. 5
    
6.
Flett K, Youngster I, Huang J, McAdam A, Sandora TJ, Rennick M, et al. Hand, foot, and mouth disease caused by coxsackievirus a6. Emerg Infect Dis 2012;18:1702-4.  Back to cited text no. 6
[PUBMED]    
7.
Bernier V, Labrèze C, Bury F, Taïeb A. Nail matrix arrest in the course of hand, foot and mouth disease. Eur J Pediatr 2001;160:649-51.  Back to cited text no. 7
    


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