From the Research
Treatment for nail changes after hand, foot, and mouth disease (HFMD) primarily involves supportive care while waiting for natural regrowth, as evidenced by the most recent study 1 published in 2025. No specific medications are needed as nail shedding (onychomadesis) is a temporary condition that resolves on its own within 1-2 months. During recovery, protect the affected nails by:
- Keeping them short
- Avoiding harsh chemicals
- Wearing gloves for wet work
- Applying moisturizing lotions containing urea or lactic acid to reduce brittleness Biotin supplements (2.5-5mg daily) may help strengthen regrowth, though evidence is limited, as noted in various studies 2, 3, 4. Nail changes occur because HFMD viral infection temporarily disrupts the nail matrix where nail growth begins, causing a growth arrest line (Beau's line) and sometimes complete separation, as explained in a study on the mechanism of onychomadesis 5. Parents should understand this is a benign, self-limiting process that doesn't require medical intervention unless signs of secondary infection develop, such as increasing pain, swelling, or discharge around the nail bed. The exact mechanism of onychomadesis following HFMD is believed to be caused by certain novel viruses, mostly Coxackievirus A6 (CVA6), which may damage the nail matrix, as concluded in a study published in 2019 5. It is essential for physicians to be familiar with atypical presentations caused by novel viruses to avoid misdiagnosis and inform patients of the possibility of onychomadesis that may take place weeks later, as reported in a case series 4 and a case report 1.