We searched PubMed for articles published from Jan 1, 1960, to July 31, 2013, with the search terms “coxsackievirus”, “hand, foot, and mouth disease”, “atypical hand, foot, and mouth disease”, and “onychomadesis”. Additionally, each author searched their personal files and the reference lists of retrieved articles were searched manually.
Grand RoundAtypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6
Section snippets
Case report
A boy aged 9 months presented to his primary care paediatrician with a 1 day history of fever and papular exanthem. The skin lesions had appeared first around the mouth and progressed to involve other areas of the face, trunk, buttocks, and extremities with evolution of some papules to larger vesicular lesions. The infant was febrile with a rectal temperature of 39·4°C but seemed to be comfortable. The skin lesions were distributed most prominently on the calves and the backs of the hands, with
Enteroviruses
The human enteroviruses cause a spectrum of acute illnesses, including self-limited syndromes characterised by fever and diffuse lesions involving the skin, oral mucous membranes, or both. Among these is hand, foot, and mouth disease, a common, highly contagious disease that mainly affects young children. Multiple outbreaks of hand, foot, and mouth disease are reported worldwide every year. The principal cause is Coxsackie virus A enteroviruses, especially Coxsackie virus A16, and the closely
Conclusions
Atypical hand, foot, and mouth disease caused by a new strain of Coxsackie virus A6 affects children worldwide. This syndrome is characterised by high fever, generalised vesiculobullous lesions that ulcerate and scab, and onychomadesis and is seen mostly in young children. Skin involvement might be more extensive in patients with eczema than in those without. Differential diagnosis must include a varicella zoster virus infection, eczema herpeticum, and bullous impetigo. Almost all cases of
Search strategy and selection criteria
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