title: Unusual skin manifestation of hand, foot and mouth disease associated with coxsackievirus A6: cases report.
abstract: BACKGROUND
  Hand, food, and mouth disease (HFMD) is a highly contagious disease caused by enteroviruses infection. It is a health problem in young children under 5 years of age worldwide. The common causative agents are coxsackievirus A 16 (CA16) and enterovirus 71 (EV71). In recent years, coxsackievirus A6 (CA6) has emerged to be one of the major etiologic agents of HFMD worldwide including in Thailand.
  
  
  METHODS
  We reported cases with unusual skin manifestations of CA6-associated HFMD such as widespread severe cutaneous eruption, large vesicles (varicelliform), purpuric-like lesions or Gianotti-Crosti like eruptions.
  
  
  RESULTS
  Molecular characterization of the CA6 strains from those patients found that all were clustered in the same group of CA6 that are currently circulating in Thailand.
  
  
  CONCLUSIONS
  Clinicians need to be aware of the expanded range of cutaneous findings in CA6-associated HFMD in order to properly consider the diagnosis, management and prevention.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, 10330 Thailand.
authors.forename: Susheera
authors.initials: S
authors.lastname: Chatproedprai
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, 10330 Thailand.
authors.forename: Therdpong
authors.initials: T
authors.lastname: Tempark
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, 10330 Thailand.
authors.forename: Nasamon
authors.initials: N
authors.lastname: Wanlapakorn
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, 10330 Thailand.
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Puenpa
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, 10330 Thailand.
authors.forename: Siriwan
authors.initials: S
authors.lastname: Wananukul
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, 10330 Thailand.
authors.forename: Yong
authors.initials: Y
authors.lastname: Poovorawan
keywords: Coxsackievirus A6; Hand, foot and mouth disease; Unusual skin presentation