How to cite APA:

Pazmiño, A., Solórzano, D. (2024)

Exploring Onychomadesis

secondary to hand-foot-mouth: medical review and case report

Repique, 6(1), 1-20

Vol. 6 No. 1

January - June 2024

e-ISSN: 2550-6676

pp 51-57

Exploring Onychomadesis secondary to hand-foot-mouth:

medical review and case report

Cristina Aileen Pazmiño

Solórzano*

Cristina Dolores Solórzano Torres

Summary

Onychomadesis is a late manifestation associated with hand-foot-

mouth disease. The diagnosis is made by physical examination and

dermatoscopy showing detachment of the nail plate. No

pharmacological treatment is required and it resolves over a course

of 12 weeks.

Keyword:

Onychomadesis, Dermatoscopy, coxsackie

Explorando la Onicomadesis secundaria a mano-pie-boca:

revisón médica y reporte de caso

Resumen

La onicomadesis es una manifestación tardía asociada a enfermedad

mano pie boca. El diagnostico se realiza mediante examen físico y

dermatoscopia que muestran el desprendimiento de la lámina

* General Practitioner, Centro de la piel Dr. Úraga cristinapazsol@gmail.com, https://orcid.org/0000-

0002-0138-8129

* Dermatologist, Centro de la piel Dr Úraga, cris_solorzano39@yahoo.es, http://orcid.org/0000-0002-

85229861

Cristina Aileen Pazmiño Solórzano, Cristina Dolores Solórzano Torres

ungueal. No se requiere de un tratamiento farmacológico y se

resuelve en un curso de 12 semanas.

Palabra clave:

Onicomadesis, Dermatoscopia, coxsackie

Received :

12-10-2023

Approved:

20-12-2023

INTRODUCTION

Hand-foot-and-mouth disease is a pathology largely caused by

coxsackievirus serotypes A6, A10, A16 and A71. It is most prevalent

during the summer season and usually affects children from 6

months to under 10 years of age; however, there are cases reported

in adolescents and adults. (1-3)

Incubation time may vary according to age, but is estimated to last

about 4 to 6 days. Onset symptoms are fever, myalgia and even

abdominal pain associated with cutaneous manifestations: painful

ulcers on oral and genital mucosa and vesicles on palms of hands

and soles of feet that usually resolve after 7 days. (2-6)

Among the mild manifestations of hand-foot-and-mouth syndrome,

beau's lines and onychomadesis have been found; on the other

hand, encephalomyelitis and flaccid paralysis have been reported

as part of the severe complications. (5)

The aim of this article is to review the literature on onychomadesis

following hand-foot-mouth syndrome, a manifestation that occurs

in some patients.

Clinical case

A female patient of 3 years and 6 months of age comes with her

mother for consultation due to nail lesions on the hands and right

foot of approximately 3 days of evolution. Her relative had no

previous trauma, however, 4 weeks ago she mentions a condition

Repique. Revista de Ciencias Sociales.

Vol. 6 No. 1 - 2024

January - June

characterized by vesicles on the palms of the hands and feet

accompanied by ulcers on the tongue and throat, diagnosed as

hand foot mouth syndrome by a physician at the same

dermatological center. Physical examination revealed detachment

of the nail plates on the index finger of the right hand, third finger

of the left hand and first orthotic of the right foot.

RESULTS

Image1

detachment of the

nail plate on hands

Image2.

detachment of the nail

plate on the first orthotic of the right

foot.

Image 3

Dermatoscopic

assessment of

onychomadesis of the

right foot

Cristina Aileen Pazmiño Solórzano, Cristina Dolores Solórzano Torres

Onychomadesis is the detachment of the proximal nail plate from

the matrix that does not affect the distal part of the nail; it has been

related to autoimmune diseases, trauma, medications or patients

undergoing chemotherapy sessions. (7-10)

Hand-foot-mouth syndrome is usually a late manifestation,

occurring 30 to 90 days after coxsackievirus infection, and is not

associated with signs of inflammation or pain. The relationship of

onychomadesis following hand-foot-mouth syndrome was first

described in 2000 in Chicago, USA.

At present, a specific mechanism of onychomadesis as a late

manifestation of hand-foot-mouth syndrome has not been

described; however, Shikuma et al. indicate that the cause of the

damage occurs mainly due to the replication of enteroviruses,

which were detected in fragments of detached nail plates that as a

consequence generate dystrophy of the nail matrix. (11) On the

other hand, Chiu and collaborators mention that the presence of

"cutaneous lesions around the nail matrix can be a possible cause

of onychomadesis associated to virus". (12)

The diagnosis is made by physical examination and a good

anamnesis is necessary to determine the causative factor of this

manifestation; laboratory tests may be indicated only in case of

suspicion of any other etiological agent not associated with hand-

foot-and-mouth disease. In dermoscopy, Beau's lines can be

observed, which are transverse lines of the lamina, detachment of

the proximal part of the nail plate without other periungual

alteration. (9) Due to being a silent manifestation it does not require

pharmacological treatment since it resolves in a course of 12 weeks;

however, general indications are given to parents such as keeping

the nail area clean and avoiding direct lesions on the nail (10,13).

(10,13)

Repique. Revista de Ciencias Sociales.

Vol. 6 No. 1 - 2024

January - June

CONCLUSIONS

Onychomadesis, a late manifestation associated with hand-over-

mouth disease first reported in 2000, is a poorly studied pathology

that, with further study, would allow a better diagnostic approach.

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