Yes, Hand, Foot, and Mouth Disease Can Cause Nail Peeling
Hand, foot, and mouth disease (HFMD) is well-documented to cause nail changes including nail shedding (onychomadesis) and Beau's lines, typically appearing 3-6 weeks after the initial infection. This is a recognized late complication that resolves spontaneously without treatment.
Mechanism and Timing
- HFMD causes temporary arrest of the nail matrix, which manifests weeks after the acute illness due to the slow growth rate of nails 1, 2.
- Nail changes typically appear after a mean of 4 weeks following the initial HFMD symptoms 3.
- The nail dystrophies occur because the viral infection disrupts normal nail plate formation at the matrix level 4.
Clinical Presentation
- Onychomadesis (complete nail shedding) occurs in approximately 67% of patients who develop nail changes after HFMD 3.
- Beau's lines (transverse grooves across the nail) occur in approximately 33% of patients with post-HFMD nail changes 3.
- Multiple nails are typically affected, most commonly on the hands and feet 2, 3.
- The nails will regrow normally without intervention once the matrix recovers 3, 4.
Key Management Points
- Reassurance is the primary intervention - these nail changes are self-limited and require no treatment 3, 4.
- Parents and patients should be counseled that nail shedding or lines appearing 3-6 weeks after HFMD are expected late findings 1, 5.
- No diagnostic testing or invasive procedures are needed when there is clear antecedent HFMD 3.
Important Caveats
- Consider HFMD in the differential diagnosis when evaluating any child presenting with unexplained nail shedding or dystrophy 4, 5.
- The nail changes may occur even after mild or atypical HFMD presentations where the initial diagnosis was not obvious 4.
- Coxsackievirus A6 has been associated with more severe HFMD presentations and nail complications 1.
- Complete nail regrowth typically takes several months, but parents should be reassured this is normal and expected 3, 4.