Dermatological spectrum of hand, foot and mouth disease from classical to generalized exanthema.
BACKGROUND
Hand, foot and mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it has been suggested that HFMD is related to coxsackie virus A6 (CV-A6) when there is an atypical rash. The objective of the study is to determine the dermatological pattern of HFMD and to identify the virus serotypes associated with a specific dermatological pattern.


METHODS
A prospective, cross-sectional study was conducted in 7 pediatric dermatology units in France from March 2010 to February 2012. All children with clinically suspected diagnosis of HFMD were included. Clinical data were collected and swabs from the nasopharynx and vesicles were taken for reverse transcription polymerase chain reaction and genotyping. Only children with confirmed HFMD--defined by clinical diagnosis of HFMD and positive enterovirus polymerase chain reaction results--were included for analysis.


RESULTS
One hundred and four children consulted for suspected HFMD, including 89 (mean age: 25.7 months; sex ratio M/F 1.54) with confirmed HFMD. Seventy-eight (87.6%) had skin lesions on sites other than hand, feet and mouth. Thirty-seven (41.5%) had 5 or more anatomical sites involved (hand, feet and mouth, buttocks, legs, arms and trunk) considered as widespread exanthema. Widespread vesicular exanthema was observed with both CV-A6 and CV-A16. Peri-oral rash was associated with CV-A6 (P < 0.001).


CONCLUSIONS
HFMD has a clinical spectrum ranging from classical to generalized vesicular exanthema. Generalized and atypical exanthema were observed with both CV-A6 and CV-A16 infections. CV-A6 is associated with peri-oral rash.
From the *Unité de Dermatologie Infectiologie, CHI Fréjus Saint Raphaël, Fréjus; †Centre National de Référence des Entérovirus, Laboratoire de Virologie Est des Hospices Civils deLyon, Groupement Hospitalier Est, Bron cedex; ‡Unité de Dermatologie pédiatrique, Centre de référence maladies rares de la peau, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux; §Service de Pédiatrie, CHG Grasse, Grasse; ¶Consultations de pédiatrie, hopitaux pediatriques CHU-Lenval, Service de Dermatologie, Hôpital Archet II, CHU de Nice, Nice; ‖Unité de Dermatologie Pédiatrique, Hôpital Femme Mère Enfant, CHU Lyon, Bron; **Service de dermatologie, Hôpital Trousseau, Université François Rabelais, Tours; ††Service de Dermatologie, CHU Pontchaillou, Rennes; and ‡‡Département de Virologie et d'Immunologie Biologique and Laboratoire EA 2968, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France.
Thomas
T
Hubiche
Isabelle
I
Schuffenecker
Franck
F
Boralevi
Christine
C
Léauté-Labrèze
Laure
L
Bornebusch
Christine
C
Chiaverini
Alice
A
Phan
Annabel
A
Maruani
Juliette
J
Miquel
Marie-Edith
ME
Lafon
Bruno
B
Lina
Pascal
P
Del Giudice
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004770:Enterovirus; D005076:Exanthema / Q000145:classification / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D005602:France / Q000453:epidemiology; D006232:Hand, Foot and Mouth Disease / Q000145:classification / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D012867:Skin / Q000473:pathology