Can hand, foot, and mouth disease cause fingernail and toenail loss?

Hand, Foot, and Mouth Disease Can Cause Fingernail and Toenail Loss

Yes, hand, foot, and mouth disease (HFMD) can cause fingernails and toenails to fall out, a condition known as onychomadesis, which typically occurs 1-2 months after the initial infection and resolves spontaneously without treatment. 1, 2

Mechanism and Presentation

• Onychomadesis (nail shedding) is a recognized late complication of HFMD, characterized by separation of the nail plate from the nail matrix, leading to eventual detachment of the nail 2
• The condition typically develops 1-2 months after the initial HFMD infection, suggesting it is a post-infectious immune response rather than direct viral damage 3
• Nail changes primarily present as painless elevation of the nail bed at the proximal region, which progresses to complete detachment of the nail plate 1
• Both fingernails and toenails can be affected, with fingernails more commonly involved than toenails 3

Epidemiology and Risk Factors

• Studies show that approximately 20.5% of children with HFMD develop nail changes 3
• The condition affects children aged 1-5 years most commonly, with boys (25.8%) more frequently affected than girls (10.6%) 3
• Nail changes are rare in children younger than 1 year of age 3
• The condition may be associated with atypical forms of HFMD, suggesting an altered host response to common coxsackievirus infections 1

Clinical Course and Management

• Nail changes typically last for 1-8 weeks, most commonly around 4 weeks 3
• The condition is self-limiting and resolves spontaneously without specific treatment 1, 3
• New, healthy nail growth replaces the shed nails over approximately three months 1
• No relapses or new nail involvement typically occur after resolution 3

Differential Diagnosis

• It's important to distinguish HFMD-related nail shedding from other causes of nail dystrophy such as:
  • Fungal infections (onychomycosis), which typically present with thickening, discoloration, and friable nail texture 4
  • Psoriatic nail changes, which may include ridging but are usually accompanied by other nail manifestations 5
  • Traumatic nail injuries, which often show characteristic patterns of damage 5
  • Bacterial infections of the nail fold (paronychia), which present with painful erythema and swelling 5

Patient Education and Reassurance

• Parents should be informed that nail shedding is a benign, self-limited complication of HFMD 1
• No specific treatment is required for the nail changes 3
• The condition does not indicate increased severity of the underlying HFMD infection 6
• Complete recovery with normal nail regrowth can be expected 1

When to Seek Medical Attention

• Medical evaluation is recommended if:
  • The nail changes are accompanied by pain, inflammation, or signs of infection 5
  • The nail changes persist beyond the expected timeframe (3-4 months) 3
  • There are other concerning symptoms such as fever or systemic illness 6

Understanding that onychomadesis is a recognized complication of HFMD can prevent unnecessary concern and inappropriate treatments, as the condition resolves spontaneously with time and proper nail care.