Onychomadesis and hand, foot and mouth disease--is there a connection?

Editorials Onychomadesis and hand, foot and mouth disease – is there a connection? Citation style for this article: Haneke E. Onychomadesis and hand, foot and mouth disease – is there a connection?. Onychomadesis is the spontaneous separation of the nail plate from the matrix, a kind of proximal onycholy-sis, and is a common phenomenon due to arrest of nail formation for a certain period. Short-term slowing down of nail formation leads to Beau's lines, while long-term stop of nail growth will cause onychomad-esis and even nail shedding. Hand, foot and mouth disease (HFMD) is a relatively common viral infection often seen as small epidemics in autumn or spring. It is characterised by oval blisters around the nails, on palms and soles with the long axis of the vesicles running along the dermatoglyphs, and by aphthoid small ulcerations of the oral mucosa. Small children are mostly infected, but probably many parents are non-symptomatic carriers as the condition usually runs a very mild course. A relationship between HFMD and onychomadesis has been proposed already ten years ago [1,2], but only recently Finnish and Spanish authors observed a sufficient number of children developing onychomadesis approximately six weeks after they had suffered from HFMD [3-6] that makes this appear more than a chance association. An article by Guimbao and coworkers published in today's issue of Eurosurveillance describes an outbreak of onychomadesis in Saragossa (Spain) in July 2008 [7]. The authors noticed that a large proportion of the patients had had HFMD a few weeks before and initiated a retrospective cohort study that indicated a link between the two diseases. They conclude that onycho-madesis may be a late complication of HFMD. From these authors' and the previous ones' observation there is no doubt that there is a temporal link between HFMD and onychomadesis. The question is now: Is the virus, more specifically the enterovirus causing HFMD, really the cause of onycho-madesis? While the number of onchomadesis cases in these young patients suggests it, could it have been caused rather by the inflammation so close to the nail matrix? Or could it have been due – of course much less likely – to intensive hygienic measures taken after HFMD broke out in the nurseries? It is well known that maceration favours Candida infections and allergic contact dermatitis, which can also cause onychomad-esis [8]. The timing of viral determination from stools and pharynx samples taken one to …