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Dermatological Spectrum of Hand, Foot and Mouth Disease from Classical to Generalized Exanthema

Hubiche, Thomas MD*; Schuffenecker, Isabelle MD, PhD; Boralevi, Franck MD, PhD; Léauté-Labrèze, Christine MD; Bornebusch, Laure MD§; Chiaverini, Christine MD, PhD; Phan, Alice MD; Maruani, Annabel MD, PhD**; Miquel, Juliette MD††; Lafon, Marie-Edith MD, PhD‡‡; Lina, Bruno MD, PhD; Del Giudice, Pascal MD*on behalf of the Clinical Research Group of the French Society of Pediatric Dermatology (Groupe de recherche clinique de la société française de dermatologie pédiatrique)

The Pediatric Infectious Disease Journal: April 2014 - Volume 33 - Issue 4 - p e92–e98
doi: 10.1097/INF.0000000000000120
Original Studies

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.

Accepted for publication October 9, 2011.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Thomas Hubiche, MD, Unité de Dermatologie Infectiologie, CHI Fréjus Saint Raphaël, 240 avenue de Saint Lambert, 83600 Fréjus, France. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.