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Open AccessArticle

The Mechanism of Onychomadesis (Nail Shedding) and Beau’s Lines Following Hand-Foot-Mouth Disease

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Department of Dermatology, Pingtung Christian Hospital, Pingtung 90059, Taiwan
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Department of Dermatology, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
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College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
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Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taipei 100, Taiwan
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Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Cardiovascular Division, Microscope Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Department of Dermatology, Research Center of Cutaneous Disorders, Chung Shan Hospital, Taipei 106, Taiwan
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Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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Department of Dermatology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
*
Authors to whom correspondence should be addressed.
Viruses 2019, 11(6), 522; https://doi.org/10.3390/v11060522
Received: 30 March 2019 / Revised: 28 May 2019 / Accepted: 3 June 2019 / Published: 6 June 2019
(This article belongs to the Special Issue Enteroviruses)
Background: Nail changes, including onychomadesis (nail shedding) and Beau’s line, following hand-foot-mouth disease (HFMD) are a common emergence at the stage of late complications of HFMD. However, the exact mechanism is still unknown. Therefore, we conducted this study to elucidate the mechanism of nail changes following HFMD. Methods: We collected 11 patients suffering from onychomadesis following HFMD. Nail samples from all of them were collected. Real time reverse transcription polymerase chain reaction (RT-PCR) and sequencing for human enteroviruses (HEV) were performed. Throat swabs for RT-PCR and sequencing for HEV were performed for three cases. Results: RT-PCR demonstrated the presence of Coxackievirus A6 (CVA6) in nail samples from three patients and one with Echovirus. Conclusion: In conclusion, we believe that the major cause of onychomadesis following HFMD is that certain novel viruses, mostly CVA6, are virulent and may damage nail matrix. Direct injury caused by cutaneous lesions of HFMD around nail matrix is a minor cause. There are still other virulent HEV which may result in onychomadesis. In addition, the novel strain of CVA6 also causes atypical clinical presentations, such as adult involvement and delayed-onset palmar and plantar desquamation. Physicians should be familiar with atypical presentations caused by novel viruses to avoid misdiagnosis and even inform patients of the possibility of onychomadesis that may take place weeks later to reassure patients. View Full-Text
Keywords: onychomadesis; Coxsackievirus A6; hand-foot-mouth disease onychomadesis; Coxsackievirus A6; hand-foot-mouth disease
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Chiu, H.-H.; Liu, M.-T.; Chung, W.-H.; Ko, Y.-S.; Lu, C.-F.; Lan, C.-C.E.; Lu, C.-W.; Wei, K.-C. The Mechanism of Onychomadesis (Nail Shedding) and Beau’s Lines Following Hand-Foot-Mouth Disease. Viruses 2019, 11, 522.

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