Case Letter
Onychomadesis secondary to hand-foot-and-mouth disease: report of two cases
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"titulo" => "Onychomadesis secondary to hand-foot-and-mouth disease: report of two cases" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "268" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juliana Polizel Ocanha Xavier, José Cândido Caldeira Xavier Junior" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Juliana Polizel Ocanha" "apellidos" => "Xavier" "email" => array:1 [ 0 => "jpocanha@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Cândido Caldeira Xavier" "apellidos" => "Junior" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Medicina, Centro Universitário Católico Salesiano Auxilium, Unisalesiano, Araçatuba, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 551 "Ancho" => 905 "Tamanyo" => 47666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Right hand from the 7-year-old showing onychomadesis in third and fourth fingers.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although onychomadesis secondary to hand-foot-and mouth disease (HFM) is an an uncommon clinical manifestation; it threatens parents and child caregivers. In a case series of 145 Thai patients, it occurred in 5–37% of cases, depending on the virus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> HFM is more frequently caused by coxsackie virus, subtype A6, but some enterovirus and echovirus may also be involved. It is common in children below 10 years of age,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and manifests with flu-like symptoms (fever, limphadenomegaly, dizziness, vomiting and discomfort) associated to canker sores in the oral mucosae and bullae on the hands and feet. Oral-faecal transmission for 30 after the resolution of symptoms and skin lesions. Nail changes often observed in HFM are Beau lines, leukonychia, and onychomadesis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Beau lines are white transverse grooves, resulting from temporary stop nail plate formation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Onychomadesis may be a more severe form of this commitment, when nail growth is interrupted for one or two weeks, resulting in detachment of the nail plate from nail bed. The new nail grows without connection to the older one, leading to splitting and detachment of the older nail. It has been proposed that this alteration may be caused by toxic direct action of the virus in the matrix or by the inflammation secondary to maceration of digital bullae.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> According to a case series,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> onychomadesis is more usual in HFM caused by Coxsackie A6 virus than other viruses. Nevertheless, a Spanish study,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> which investigated an onychomadesis outbreak (311 cases) showed high frequency of HFM as a possible cause (60%), a finging confirmed by identifying coxsackie and enterovirus in faecal samples<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Obs. adicionar referiencia subscrito Treatment is symptomatic because it is a self-limited disease with rare sequelae. We present a 3-year-old male patient (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and a 7-year-old female patient (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>)with onychomadesis secondary to HFM, with history of flu-like symptoms, followed up by oral and acral lesions. Nail changes appeared around 14 days after the symptoms began in the first case and 10 days in the second one. They had complete resolution of the nail alterations, with no specific treatment and no sequelae. Parent counselling about this manifestation is necessary to avoid untimely therapeutics and unnecessary emergency consultations.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0010" class="elsevierStylePara elsevierViewall">Juliana Polizel Ocanha Xavier: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0015" class="elsevierStylePara elsevierViewall">José Cândido Caldeira Xavier Junior: Approval of the final version of the manuscript; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-05" "fechaAceptado" => "2019-06-13" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Ocanha-Xavier JP, Xavier Jr JCC. Onychomadesis secondary to hand-foot-and-mouth disease: report of two cases. An Bras Dermatol. 2020;95:266–8.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Private Clinic Tiradentes, Vila Mendonça Araçatuba, SP, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 735 "Ancho" => 1305 "Tamanyo" => 80727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hands from patient with 3 years old, showing Beau lines in almost every nail, and onychomadesis in second (both sides) and fourth finger.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 551 "Ancho" => 905 "Tamanyo" => 47666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Right hand from the 7-year-old showing onychomadesis in third and fourth fingers.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 42528 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Details from first finger of the right hand from the 7-year-old patient, showing detachment of the previous nail from the newer one.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. 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Salazar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2010.01161.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2011" "volumen" => "28" "paginaInicial" => "1" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20553401" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000002/v1_202004180640/S0365059620300489/v1_202004180640/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000002/v1_202004180640/S0365059620300489/v1_202004180640/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300489?idApp=UINPBA00008Z" ]
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| 2023 March | 78 | 57 | 135 |
| 2023 February | 83 | 29 | 112 |
| 2023 January | 72 | 55 | 127 |
| 2022 December | 96 | 36 | 132 |
| 2022 November | 83 | 52 | 135 |
| 2022 October | 108 | 49 | 157 |
| 2022 September | 95 | 64 | 159 |
| 2022 August | 109 | 39 | 148 |
| 2022 July | 100 | 50 | 150 |
| 2022 June | 101 | 49 | 150 |
| 2022 May | 94 | 63 | 157 |
| 2022 April | 73 | 49 | 122 |
| 2022 March | 134 | 70 | 204 |
| 2022 February | 89 | 44 | 133 |
| 2022 January | 68 | 109 | 177 |
| 2021 December | 39 | 53 | 92 |
| 2021 November | 50 | 47 | 97 |
| 2021 October | 71 | 83 | 154 |
| 2021 September | 28 | 43 | 71 |
| 2021 August | 43 | 41 | 84 |
| 2021 July | 36 | 34 | 70 |
| 2021 June | 30 | 49 | 79 |
| 2021 May | 45 | 74 | 119 |
| 2021 April | 103 | 197 | 300 |
| 2021 March | 52 | 47 | 99 |
| 2021 February | 24 | 17 | 41 |
| 2021 January | 20 | 15 | 35 |
| 2020 December | 30 | 21 | 51 |
| 2020 November | 11 | 12 | 23 |
| 2020 October | 17 | 10 | 27 |
| 2020 September | 12 | 14 | 26 |
| 2020 August | 10 | 6 | 16 |
| 2020 July | 20 | 8 | 28 |
| 2020 June | 20 | 16 | 36 |
| 2020 May | 14 | 11 | 25 |
| 2020 April | 4 | 5 | 9 |
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