Samantha I et al.
Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with the coxsackievirus A6 (CVA6), were first reported in 2008, with an increase in reports since then worldwide. Atypical lesions of HFMD often involve sedes other than the palms of the hands and soles of the feet and tend to have unusual and polymorphic morphology.
A systematic review was conducted on the clinical features and outcomes of pediatric HFMD with atypical skin manifestations by examining Eighty-five studies, representing 1,359 cases with a mean age of 2.4years and a male predominance of 61%. The morphologies mostù reported were vesicles (53%), papules (49%) and boils (36%). Other morphologies included herpetic-like eczema (19%), purpuric/petechial (7%) and Gianotti Crosti-like (4%). Common atypical sites included arms and/or legs (47%), face (45%) and trunk (27%). CVA6 è was identified in 63% of cases. Symptoms resolved on average in 10days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and scaling (4%), which occurred on average 3 and 2 weeks after symptoms, respectively.
Because of unusual morphologies resembling other conditions, HFMD with atypical skin findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalizations, and treatments. Greater awareness of atypical manifestations of HFMD is needed to improve patient care.