title: Onychomadesis after hand-foot-and-mouth disease outbreak in northern Greece: case series and brief review of the literature.
abstract: BACKGROUND
  Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis was described as a late complication of hand-foot-and-mouth disease (HFMD). Onychomadesis outbreaks following HFMD have been reported in many countries worldwide.
  
  
  OBJECTIVE
  To present a case series of onychomadesis in children, following HFMD outbreak in Northern Greece, and review literature data.
  
  
  METHODS
  Children with evident onychomadesis attending the outpatient clinic between November 2012 and January 2013 were included in the study. A questionnaire including demographic personal and family history information of the children was completed by the parents. Patients were clinically examined, and their pediatric and dermatological records were studied to confirm precedent HFMD. Direct microscopic examination and cultures for fungi were performed. Exposure of participants to coxsackievirus, based on serology testing during infection, was also recorded.
  
  
  RESULTS
  Sixty-eight children with onychomadesis were included. The mean number of affected nails was 8.82. Fingernails were more often involved. Previous clinical diagnosis of HFMD was confirmed in 67/68 cases. The mean time from HFMD diagnosis to onychomadesis development was 39.6 days (range: 28-56 days, STD: 7.33). Direct microscopic examination, as well as cultures for fungal species, was negative for the whole sample size. All the nail changes were transient with spontaneous regrowth after 1-4 months.
  
  
  CONCLUSIONS
  Our data indicate that onychomadesis outbreak in the region of Thessaloniki during fall-winter 2012-13 was highly related to the outbreak of HFMD. Our study reinforces existing evidence for the association between onychomadesis and HFMD.
authors.affiliation: State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Apalla
authors.affiliation: First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Sotiriou
authors.affiliation: State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Pikou
authors.affiliation: State Clinic, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Lefaki
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Aimilios
authors.initials: A
authors.lastname: Lallas
authors.affiliation: First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lazaridou
authors.affiliation: First Department of Dermatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Demetris
authors.initials: D
authors.lastname: Ioannides
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000818:Animals; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D005385:Fingers; D005536:Foot-and-Mouth Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009264:Nails, Malformed / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014034:Toes