Big Picture Clinical metamorphosis of hand, foot and mouth disease (HFMD) Ashok Kapse* Department of Pediatrics, Kapse Children Hospital, Surat, Gujarat 395001, India article info Article history: Received 14 September 2013 Accepted 16 September 2013 Available online xxx Keywords: HFMD CA16 EV71 Papulovesicular Onychomadesis abstract HFMD is an acute viral exanthematous disorder of early childhood. Characterized by erythematous papulovesicular eruptions around mouth, on palms, soles, and buttocks, syndrome is caused by eleven types of enteroviruses; Coxsackie A16 is by far the com- monest one. Generally a mild and self recoverable disease some of the recent outbreaks have reported serious neurological complications mainly when Enterovirus 71 is the causative agent. Onychomadesis, a noninflammatory nail dystrophy is lately discovered finding associated with HFMD. Copyright ª 2013, Indian Academy of Pediatrics, Infectious Disease Chapter. All rights reserved. First reported in New Zealand in 1957, hand, foot and mouth disease (HFMD) is a clinical syndrome characterized by acute onset fever, oral ulcers, and papulovesicular rashes on the hands, feet and buttock as salient features. 1 Her- pangina (HP) is a limited edition of the disease with char- acteristics of having fever and oral ulcers however devoid of skin rash. 1 HFMD is primarily a disease of early childhood and is caused by eleven different yet related enteroviruses; Cox- sackievirus A16 is by far the commonest. 2 Infection by one strain is believed to cross protect child from other serotypes however recently recurrences are observed. HFMD or HP was generally known as a self-limiting disease that pursued a mild clinical course. However, in early 1970’s disease took an ominous turn, cases of HFMD started developing neurological complications and some of them even succumbed. In- vestigations of these cases revealed that majority of these fatal cases were caused by enterovirus 71. 2 Since late 1990 enterovirus 71 caused HFMD and HP has evolved as a poten- tially fatal disease and is continually being reported from the various Asian countries of the Western Pacific such as Malaysia, Taiwan, Japan, Singapore, and China. 3 Early recog- nition of serious disease and modalities of treatment and prevention are some of the targets for HFMD related research. Article attempts to provide a pictorial review of HFMD and describes its newer complications. 1. Clinical perspective Commonly occurring in childhood HFMD comes in cycles of 3e4 years. Oral mucosa and skin are the major sites of pre- sentation. Starting with mild fever disease is characterized by sudden eruptions of papulovesicular rash. * Tel.: þ91 9825943304. E-mail address: ashok.kapse@gmail.com. Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/pid pediatric infectious disease xxx (2013) 1 e5 Please cite this article in press as: Kapse A, Clinical metamorphosis of hand, foot and mouth disease (HFMD), Pediatric Infec- tious Disease (2013), http://dx.doi.org/10.1016/j.pid.2013.09.003 2212-8328/$ e see front matter Copyright ª 2013, Indian Academy of Pediatrics, Infectious Disease Chapter. All rights reserved. http://dx.doi.org/10.1016/j.pid.2013.09.003