Hand, Foot, and Mouth Disease (HFMD) Can Present with Lesions on the Buttocks
Yes, Hand, Foot, and Mouth Disease (HFMD) commonly presents with lesions on the buttocks in addition to the classic locations of hands, feet, and mouth. 1, 2
Clinical Presentation and Distribution of Lesions
- HFMD typically presents with vesicular lesions on the hands, feet, and oral mucosa, but the buttocks are a common additional site of involvement 1
- Up to 87.6% of children with confirmed HFMD have skin lesions on sites other than hands, feet, and mouth, including the buttocks 1
- The disease can present with a spectrum ranging from classical distribution to widespread exanthema involving multiple body sites 1
Atypical Presentations and Variants
- Recent outbreaks have shown an increase in atypical presentations of HFMD with more extensive rash distribution 2, 3
- Approximately 41.5% of children with HFMD develop widespread exanthema involving 5 or more anatomical sites (hands, feet, mouth, buttocks, legs, arms, and trunk) 1
- "Eczema coxsackium" is a variant where lesions appear predominantly in areas of pre-existing eczematous dermatitis, which can include the buttocks 4
- Three distinct phenotypes of atypical HFMD have been identified 5:
- Acral form: Lesions with mainly acral distribution but can extend beyond classic sites
- Diffuse form: Lesions extended to the trunk and other areas
- Eczema coxsackium: Lesions concentrated on pre-existing eczematous areas
Viral Etiology and Clinical Correlation
- Both Coxsackievirus A6 (CV-A6) and Coxsackievirus A16 (CV-A16) can cause widespread vesicular exanthema including buttock involvement 1
- CV-A6 is particularly associated with atypical presentations and more extensive rash distribution 3, 4
- CV-A6 was detected in 9 of 11 genotyped cases of atypical HFMD in a prospective study 5
Clinical Implications
- Recognition of buttock involvement in HFMD is important for accurate diagnosis and to avoid confusion with other vesicular diseases 3
- The presence of lesions on the buttocks should not exclude HFMD from the differential diagnosis but rather support it 1, 2
- Atypical presentations with extensive distribution (including buttocks) may be confused with more serious conditions such as bullous impetigo, eczema herpeticum, or varicella 4
Management Considerations
- Despite the varied distribution of lesions, the management remains supportive care regardless of whether buttock lesions are present 2
- Hygiene measures are important to prevent spread, especially when lesions are present in the diaper area 2
- No specific antiviral therapy is currently recommended for HFMD, even with atypical distribution patterns 2
In conclusion, buttock involvement is a common feature of HFMD and should be recognized as part of the clinical spectrum of this condition, especially in the context of recent outbreaks with more varied presentations.