Beau’s Line and Onychomadesis after Hand-Foot-Mouth Disease

Hand-foot-mouth disease (HFMD) is caused by enterovirus or Coxsackie virus (CV) infection. It is characterized by palmoplantar vesiculopustular eruption and erosive stomatitis [1], which enables differential diagnosis from herpangina, aphthous stomatitis, and Kawasaki disease. There are several case reports on the nail presentation of HFMD [1-10], but some clinicians are not yet familiar with this phenomenon and can make a misdiagnosis leading to unnecessary treatment. Herein we report two cases of onychomadesis that developed after HFMD. The first case was a 26-month-old boy who presented with a nail deformity on October 2, 2013. His mother mentioned that she found the deformity 1 week prior. His past medical history was insignificant except for previous febrile HFMD that was diagnosed by a local pediatrician in August. There was no history of nail trauma, previous hand dermatitis, or drug use other than acetaminophen during the course of the febrile HFMD. Laboratory test results, including complete blood cell count, admission panel, zinc, magnesium, iron, and ferritin levels, were within normal limits. Physical examination showed shedding of both thumbnails and the right index fingernail with normal proximal regrowth (Figure 1). His toenails appeared normal. The second case was a 25-month-old boy who presented with a similar nail deformity on October 30, 2013, which developed 1 month previously. His past medical history was insignificant except for nonfebrile HFMD in August. Laboratory test results, including complete blood cell count, admission panel, and zinc and ferritin levels, were within normal limits. There was no history of nail trauma, previous hand dermatitis, or drug use. Physical examination showed subtle transverse ridging of the fingernails and shedding of the toenails and fingernails with normal proximal regrowth (Figure 2).