title: Hand-foot-and-mouth disease: a new look at a classic viral rash.
abstract: OBJECTIVE
  Hand-foot-and-mouth disease (HFMD) is a common cause of viral rash in children with classic skin findings which are easily recognized by pediatricians. Recently, several atypical cutaneous manifestations of HFMD have been described. Awareness of these patterns may lead providers to appropriate diagnosis and management. This review also highlights the epidemiological patterns of more virulent strains and emerging research in disease prevention.
  
  
  RESULTS
  Classic HFMD presents with tender lesions on the hands, feet, and oral mucosa. Atypical skin findings in HFMD may be seen in children with atopic dermatitis. These include 'eczema coxsackium', in which eczematous skin is superinfected with coxsackie virus, resembling herpes infection. Nail changes, such as shedding, may follow HFMD after a latency period. Enterovirus 71 is responsible for epidemic outbreaks of HFMD in Asia, with systemic manifestations and occasionally neurological sequelae. Research is underway to develop a vaccine which could curb epidemics, but for the present, supportive care and hygiene measures are the standard of care.
  
  
  CONCLUSIONS
  Atypical manifestations of HFMD in children with atopic dermatitis may mimic herpetic superinfection. In a child presenting with nail changes, consider antecedent HFMD in the differential diagnosis. The mainstay of treatment for HMFD remains supportive care.
authors.affiliation: aDepartment of Pediatrics bDepartment of Dermatology, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nassef
authors.forename: Carolyn
authors.initials: C
authors.lastname: Ziemer
authors.forename: Dean S
authors.initials: DS
authors.lastname: Morrell
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004196:Disease Outbreaks / Q000517:prevention & control*; D020022:Genetic Predisposition to Disease; D063373:Hand Hygiene / Q000592:standards*; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D009260:Nail Diseases / Q000473:pathology* / Q000821:virology; D012720:Severity of Illness Index