Onychomadesis: nail shedding as a delayed manifestation of hand, foot, and mouth disease

Key pointsWhat is known -Onychomadesis involves the complete shedding of a nail from the proximal nail bed due to the cessation of nail plate production.-Coxsackievirus A6 and A10 have emerged as major agents of atypical hand, foot, and mouth disease (HFMD) and post-infection onychomadesis.-The nail matrix recovers spontaneously within three to six months.Reassuring parents avoids unnecessary interventions during the recovery period.What is added -Nail diseases are rare in children but should alert healthcare professionals for proper evaluation and management.-Viral replication in the nail matrix can cause temporary nail growth arrest and nail shedding.-Coxsackievirus A10 can interfere with the Wnt/-catenin signaling involved in nail growth and disrupt cell proliferation and nail stem cell differentiation.