Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Nemours Children's Hospital Delaware, Wilmington, Delaware, USA.
Pediatr Dermatol. 2024 Jan-Feb;41(1):23-27. doi: 10.1111/pde.15461. Epub 2023 Oct 25.
Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology.
A systematic review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations.
Eighty-five studies were included, representing 1359 cases with mean age 2.4 years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum-like (19%), purpuric/petechial (7%), and Gianotti Crosti-like (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10 days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2 weeks after symptoms, respectively.
Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.
手足口病（HFMD）是一种常见的儿童传染病。2008 年首次报道了柯萨奇病毒 A6（CVA6）相关的手足口病不典型皮肤表现，此后全球报道逐渐增多。手足口病的不典型皮损常累及手掌和足底以外的部位，且形态异常、多样。
我们对手足口病伴不典型皮肤表现的临床特征和结局进行了系统评价。
共纳入 85 项研究，涉及 1359 例患儿，平均年龄 2.4 岁，男性居多（61%）。最常见的皮损形态为水疱（53%）、丘疹（49%）和大疱（36%）。其他形态包括疱疹样湿疹（19%）、瘀点/瘀斑（7%）和 Gianotti-Crosti 样（4%）。不典型皮损常见于手臂和/或腿部（47%）、面部（45%）和躯干（27%）。63%的病例检测到 CVA6。平均 10 天症状缓解。总体而言，16%的病例接受了治疗，最常用的治疗方法是阿昔洛韦、静脉用抗生素或局部皮质类固醇。最常见的并发症是指甲改变（21%）和脱屑（4%），分别在症状出现后平均 3 周和 2 周出现。
由于其形态异常，类似于其他疾病，手足口病伴不典型皮肤表现可能会被误诊，导致不必要的检查、住院和治疗。因此，有必要提高对手足口病不典型表现的认识，以改善患者的护理和感染控制预防措施的咨询。
