Saturday, November 03, 2012

Loss of Nails Following Hand Foot and Mouth Disease Infection in 2 Children

I present an unusual case of 2 unrelated children who coincidentally presented to me on the same day with Hand, Foot, and Mouth Disease and then returned 7 and 8 weeks later with the same uncommon complication of this disease.

The first was an otherwise healthy 3 year old boy whose symptoms at presentation were a 2 day history of fever up to 102 degrees, and a vesicular rash on the hands, feet, buttocks and around the mouth.  A diagnosis of hand, foot and mouth disease was made, he and mom were sent home with reassurance.  No further contact was made until he presented 7 weeks later with his mother who was complaining that his nails were peeling off.  He had no other symptoms.  I had no specific explanation for this, so I inquired about any recent systemic illnesses.  She reminded me of the recent HFM infection so I did some quick research - Google Search:  "hand foot mouth disease onycholysis" and I found this article.  It describes 4 cases of onycholysis and/or onychomadesis following HFM infection.


 
 The second case involved a 20 month old girl who had initally presented with 2 day history of temp. up to 99.8 and vesicular rash on hands, feet and groin area.  The diagnosis of hand, foot and mouth disease was made and reassurance was given.  A few days later she returned with worsening of the rash but had no significant feeding problems.  There were no signs of dehydration or fever at that time, but the child now was extensively covered with the vesicular rash over all extremities, trunk and external lips.  No further treatment was recommended at that time and f/u by telephone a few days later revealed that she was finally improving and further follow up for this was planned on an as needed basis.  Our next encounter was just under 8 weeks later for an unrelated minor problem.  As we were finishing the visit, the mom said "All her fingernails and toenails fell off after she had that hand foot and mouth disease".  Indeed, on her exam, all of her fingernails had shed and were growing back with some small irregularities and indentations and the same was true for her toenails except the nail of each great toe which had not completely lost the older portions of the nails.
 



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posted by Clay @ 11/03/2012 03:57:00 PM   33 comments

33 Comments:

At 1:02 AM, Blogger joe said...

Interesting I have never seen this before.

 
At 11:02 PM, Anonymous Anonymous said...

Thank you for this information. I have 2 young sons and both of them were diagnosed with HFMD. My 2 year olds symptoms were the worst. Highest temp was 103.7. He was unable to eat or walk for several days. It's been about 8-9 weeks since both of my sons were diagnosed. My 2 year old is losing both his fingernails and toenails. So far with my 6 year old it's only been toenails.

 
At 6:50 AM, Blogger angelovmyn said...

Thank you so much for this post,
My daughter now 22 months old had HFM at the end of October, and what first looked like those white marks on all her nails )you know the ones when there is a mineral defficiency) and then when they grew out I realized they were bubbles.....

Eventually now these bubbles are peeling,
Luckily not down to bare skin, but down to a very thin layer of nail....
I was really starting to worry, and the info I found about this condition wasn't very good....but this now totally makes sense if I think about how her feet peeled for a month after the HFM....

Can you tell me if there are any other long term symptoms that I should be concerned about?

Thanks again for this post.

 
At 5:34 AM, Anonymous Anonymous said...

this has really eased my mind, my 2 year old was told he had HFM about 8 wks ago and 3 days ago his nails on his hand started peeling off, i was growing really concererd untill i read this, thank you

 
At 10:37 PM, Anonymous Anonymous said...

My son also contracted HFM from our church nursery (as did dozens of other children). After a horrible rash and fever, he did recover, but now several weeks later, I have noticed the peeling skin on his feet and now his fingernails and toenails are starting to fall off. Wish the doctor would have mentioned this, because I was on my way to schedule an appt. when I jumped on the internet and started reading about it.

 
At 4:21 AM, Anonymous Anonymous said...

Thank you for your article my 12 year old also shed her fingernails and my son lost his toenails they both had HFM 6weeks before. My daughter especially found her fingers very sore where the old nail was still attached at the side and new fingernail pushing up underneath.

 
At 10:12 PM, Anonymous Anonymous said...

I love the internet for this very reason...I was worried as my 4 year old sons nails were peeling from the bases. Thinking that he was deficient in some way..I checked the internet and found so many posts about it . Relieved to know it was lasting effect from HFM that he had 6 weeks ago and nothing more:)

 
At 7:43 AM, Blogger angelovmyn said...

I must say this was one of the only places on the Internet that I found evidence... Or more reports of it...
There certainately isn't any on webMD...etc....

Other than that a few chat forums where parents are reporting it....
Weird that There isn't any advise given by paediatricians or GP's about the possible after symptoms...

 
At 7:46 AM, Blogger angelovmyn said...

Interesting how this is one of the few places on the Internet where there are reports or discussion about this post symptom...

From the few blogs and forums that I have read, it appears to be common enough for a paediatrician or GP to make mention of as a possible side effect of this disease.... I wonder why it does not happen, and we all have to self diagnose on the Internet?

 
At 3:58 PM, Anonymous Anonymous said...

14 years old and got hfmd really bad couldn't move hands or walk on feet, weeks after getting over the virus nails started peeling off from the back while there is another nail growing underneath im not sure how to prevent or speed up the process !

 
At 2:53 PM, Anonymous Anonymous said...

my 2 year old daughter had a very bad case of this , lost all her finger and toe nails ,was hospitalized as they thought it was kawasaki disease they way her skin was turning, thank god it turned out to be just hfmd but 1 of the worst cases the doctors had seen

 
At 2:36 AM, Anonymous Anonymous said...

Ahhhhhhh!! I'm 30 and had this about 7 weeks ago and am now losing my finger nails!! Not happy but glad I finally have an answer!! Thank you!!

 
At 1:34 PM, Anonymous Anonymous said...

Thank you SO much for writing this article! My 6 yr old daughter had HFM about 6-8 weeks ago and almost all of her fingernails are falling off and a few of her toenails are gone. I have been very upset thinking something is terribly wrong with her. This was the ONLY info i have found that explains why this is happening to her. Thank God this is all it is! Thank you!!!!

 
At 12:45 AM, Anonymous Jeannette said...

my daughter was diagnosed with HFMD too and just last week she stared to lose her finger nails and her feet are pealing so much i got berry worry and call her doctor i got some good information thank you but i still seeing her doctor this fryday. !! thanks again for the 411

 
At 6:01 PM, Anonymous Anonymous said...

my son also had hand foot mouth virus high fever didn't want to eat diagnosed with the virus took almost 3 weeks for the blisters to all go away about 2 to 3 weeks later his feet completely shed all of the skin very thick skin was coming off now 2 months later all the nails on his hands are peeling from the cuticle up not from the top very painful you have to trim it daily

 
At 9:24 PM, Anonymous Anonymous said...

Thank you for writing- my 33 yo husband contracting HFM from our daughter - weeks ago and just started to get bubbles on his nails and they are peeling. Glad we have an answer!

 
At 1:34 PM, Blogger Mandii Sturlaugson said...

Thank you so much for this info! We have been to 2 pediatric drs for our 6yr old daughter wondering what is going on with our her nails. They appear to be lifting at the cuticle, chipping away and hurt (especially along the sides)-and impacts both hand and feet nails. We just got done with an expensive full blood panel/draw (after 12 hours of fasting) thinking its a vitamin issue-the dr still has not said it is from HFMD but both my husband and I feel this site is describing everything we are going thru!
Our daughter had a 'mild' case of HFMD 8 weeks ago-she had 47 sores in and around her mouth but only a few dots on her hands and feet with tingling. Now 8 weeks later, her nails are breaking away. They begin with a white mark, some pull away from the cuticle, other white spots begins to turn yellow and then nail will begin peeling/chipping away. These chips will snag on clothing and before you know it, there are large 'chunks' of nail that are lifting and snagging. The pain my daughter describes is a pinching feeling along the edge of the nail which another reader said where the old and new nail are still together and that appears correct for us too. As our chipping continues, some nails have actually turned bruised looking but that does not hurt according to my daughter. It appears at no time is there a gap in the nail down to the raw skin (I cant confirm this with the cuticle lift spots since we dont pry them up too much but once they chip away this is true) rather there is a thin new nail underneath the old chipping nail. For treatment, we are super gluing the nail 'chunks' down (including the cuticle lift spots), covering the nail with UV gel nailpolish (since it turns rock hard and lasts quite some time) then file new parts down with a file and repeat as necessary. So far this has been working. We have one nail that seems to have finished peeling which is a little more than half way up the nail but the newer nail is a little bumpy-but normal looking. We have some marks that dont start chipping until 1/3 up the nail (again another reader described a bubble blow out and I would agree with that statement).
I really wish we would have found this in the info given to us with HFMD and/or been informed by our doctors this could happen. Being mentally prepared would have made a huge difference vs finding one day 5 nails are falling off your young child with no real reason known to you! When you search nail chipping or loss of nails the pictures can be horrifying and get you more worked up then necessary. I would love to hear what to expect when this is done-do all nails fall off or just some (we are at 7 nails so far) and what do they look like afterwards-any lasting issues?
* Editor-I would love to send 2 pictures that currently show what the nails look like in each of these stages for other parents to see if you know how to do that.

 
At 9:17 AM, Anonymous Anonymous said...

HI
I am 51 years old with a 12 year old daughter. She contracted HFM and was sent home with a virus, She only had a sore throat and several sores on her hands that turned brown and eventually fell off. I however contracted a very severe case. My doctor told me I would have to go home and suffer it out for 10 days as it was a virus and nothing could be done. I had some very stressful events at the time and my job was very busy so I was very worn out. I had sores all over my hands and feet,in my throat, mouth, nose , and arms. My skin peeled off the bottom of my feet and toes completely and also on my hands. It was extremely painful and had more of a severe burning sensation. I did not go see a doctor. I had this at the beginning of November 2013 and now in Mid January 2014 by nails are starting to fall off. I have pain still and have had burning sensations since this all started.
Prior to getting sick I had a physical for a life insurance policy I took out and I received a low rate due to the fact that I am so healthy. Three days later I was very, very sick. My hands were a disaster and I had to wear gloves as they were very gross.
Now I use hand hand sanitizer every where I go.
I would suggest not touching the sores, not itching them when they are itchy. I told my daughter not to do that and her disease did not
develop into the awful case I had. She got this from a girl on the bus who was thirsty and wanted to drink from her water bottle. I had had several conversations about not sharing but of course my A student daughter needs to find out common sense things the hard way. After she saw me suffer and what happened to me - she realizes the importance of not sharing personal items. My husband was not affected by this disease at all. It was awful and I would want to have it again. I would compare it to child birth that lasts 10 days. I really suffered. I am healthy, eat carefully am not overweight and a clean person. I did kiss my daughter on the lips prior to getting this. I no longer do that. I kiss her on the cheek instead. I told one of my neighbors about this and she said all her kids had this and it was very similar to what I had. They had it over 10 years ago though. So apparently this is not rare here.

 
At 8:15 AM, Blogger Renz said...

Thank you for all the information people have posted it has been very helpful.
My 3 yr old son was diagnosed with hand foot and mouth on Christmas Day as he was sent to A&. He also had a secondary infection so was given antibiotics on his discharge. He suffered really badly but he seemed to recover well until two weeks later when his hands started to peel then the skin on his feet. Now a month on from the initial infection his nails are starting to come off on his fingers, nothing as yet on his toe nails. They are coming away from the nail bed but by bit so luckily the nail has started to grow underneath so it isn't raw.
I have searched everywhere for information on these odd symptoms but haven't had any luck other than the skin may peel. It is very helpful to know others have had the same as it starts you thinking that there is more to this than we know!

 
At 4:53 AM, Anonymous Anonymous said...

My daughters nails are now peeling I'm so worried they won't grow back normal. She is 2 and they break really low and get snagged on things any help or advice would ease? Can anyone tell how her nails will be after this is all over?

 
At 8:13 PM, Blogger Tia Schurtz said...

Thank you so much everybody for your stories. its nice to know im not alone. My 2 year old daughter and i contracted HFMD about six weeks ago and gave it to my sister and her 4 month old son. All four of us broke out in fever then the red flat rash all over our hands feet and mouth. (i had it the worst i think because im the sensitive skin type, i get everything) anyway all four of us healed up nicely but then i noticed my hands peeling and then my feet and it was horrible! chunks of skin are coming off my feet. i looked at my daughter and she too is peeling but not as bad. My sister and her son are now starting to peel too. And then Yesterday i noticed my index fingernail is starting to peel off and my daughters toenail is peeling off from the cuticle up. Im really hoping everything heals up and the nails grow out healthy. I was really starting to freak out until i read this. So thank you everyone Hopefully the ongoing odd freaky symptoms will stop soon!!!

 
At 12:05 PM, Anonymous NK said...

Thank you all for sharing this information, I was really worried that my 3yr old daughter was having these same symptoms, and I thought it might be some deficiency.. as mentioned by others, doctors should inform parents about the possibility of nails brittleness after HFM diagnosis..

 
At 9:51 PM, Blogger Ashley Rogers said...

Thank goodness I found this. My dd had HFM in Dec. Her nails started doing the same thing. Also her toe nail os doing it now, but it doesn't seem like another nail is under. Did anyone else have this problem?

 
At 12:22 AM, Blogger Julia Waters said...

Wow. Glad I found this site. My son got HIM a few weeks ago and his feet and hands are peeling really bad. Is there anything type of lotion or something that will help? I don't want to freak him out if his nails start to come off. But the hospital and then his doctor didn't say anything about the peeling.

 
At 4:39 PM, Blogger Ashley Rogers said...

I think the peeling is normal due to the blisters. I took my daughter today about her toe nail and the dr said its from HFM and to let the nail fall off and run its course. You'll notice bubbling in the nails before they fall off. Her fingernails grew them out bc we didnt notice that it was happening.

 
At 9:48 AM, Anonymous emma said...

emma.
its absolutely related. my 3 yr old and 22 month old both had hfm about fuve weeks ago and about four weeks later my 3yr has nearly lost all her finger nails and the toe nails have just begun to drop off too. bless her heart, its very uncomfortable, though they r growing back.

 
At 3:36 PM, Blogger Mitzi Lott said...

My 3 yr. old grandson came down with this 6 wks ago, has now lost one fingernail and the others are starting to come up at the cuticle his toe nails seem to be fine so far. This is so sad. Is he still contagious with his nails falling off?

 
At 6:44 PM, Blogger Unknown said...

I'm a pediatrician and in 16 years of practice I've never seen post-coxsackie B nail loss (to my knowledge). I now have 3 children in the same family with nail separation at the matrix, 1-2 nails affected each, 3 weeks after 4 siblings got HFM simultaneously (also a first for me).

Thanks for your post! It has saved me from pursuing referrals and massive toxicology workups.

 
At 2:26 PM, Blogger Tosha Foster said...

OK so 3.5 weeks ago my 20th old son and 3 old daughter, myself as well as my oldest son of 8 years got a horindus case of hfm. Now my youngest sons toe and fingernails are peeling off at bubbled cuticle two at a time after both went through skin peeling. But now he's got hfm again only days from the first sign of nails peeling. What the heck?? Can the peeling cause it to be reactive? Like the liquid from the blisters are said to be very contagious? Ugh I hate this virus! My poor little man is absolutely miserable! ! HEALP

 
At 12:38 AM, Blogger Glenda Flowers said...

My daughter is 1 years old and gf HFM a month ago and no her finger nails are falling off I wanted t know onc they fall off will they grow back the right way without th bubble an dark spot

 
At 5:07 PM, Anonymous Anonymous said...

Thank you for your posts. I also thought my two year old child had a vitamin deficiency (he's a picky eater) rather than lingering effects of an illness.

He had some sort of virus, can't recall what the dermatologist called it. Just like Hand, Foot, Mouth, but not in the mouth. He had two days of high fever and bumps all over his legs, arms, cheeks, and ears. It took three weeks for all the bumps to clear, then two weeks of peeling on the feet.

It's been two months now and he has lost one fingernail. The others are bumpy and peeling. Two toenails have turned dark and a few are brittle.

Do the nails eventually grow back normally? How long does it take for the nails to appear healthy again.

 
At 3:30 PM, Blogger Bill Catambay said...

I seem to be in the minority. My 4 year old son has never had hand food and mouth disease, or anything close to it. Yet he just recently started having his nails peel from the base up, as if two nails were growing (basically what people here are describing). There must be something else that causes this besides HFM disease. Any ideas?

 
At 8:20 PM, Blogger Summer Pietkiewicz said...

Oh thank goodness for this post. My 7yr old daughter had contracted HFMD about 5 weeks ago. She had it pretty bad on her palms, bottoms of her feet, and in her throat. Now her two index finger nails are starting to separate and I was getting scared. I wondered if it was because of HFMD. I'm sorry for everyone's little one's having to go through this as well, but I'm glad I got confirmation on my suspicions and not have to run to the doctor.

 

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