Unusual nail alterations in a child: a consequence of a common infection (a case report)

Abstract

Introduction: Onychomadesis refers to the proximal separation of the nail plate from the matrix following a temporary arrest in nail formation, leading to nail shedding. While it can be a consequence of multiple aetiologies, it is uncommon in childhood. To our knowledge, this is the first case reporting the association between onychomadesis and hand-foot-and-mouth disease in the context of primary health care in Portugal. Case description: A previously healthy 21-month-old male child, otherwise asymptomatic except for fingernail alterations, was diagnosed with hand-foot-and-mouth disease four weeks before nail changes. Comment: Beau’s lines and onychomadesis are late complications of hand-foot-and-mouth disease. Clinicians must invest in a proper and detailed patients medical history and assess recent viral infections. On the other hand, the knowledge of probable indicators and of the association between onychomadesis and hand-foot-and-mouth disease itself may avoid inadequate investigations, referrals, and treatments. Furthermore, advising and reassuring patients/parents/caregivers about possible nail alterations weeks following hand-foot-and-mouth disease may also prevent unnecessary concerns.