{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:28:35Z","timestamp":1787502515025,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Dermatology"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hand\u2010foot\u2010mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty\u2010five studies were included, representing 1359 cases with mean age 2.4\u2009years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum\u2010like (19%), purpuric\/petechial (7%), and Gianotti Crosti\u2010like (4%). Common atypical sites included the arms and\/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10\u2009days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2\u2009weeks after symptoms, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pde.15461","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T04:13:05Z","timestamp":1698207185000},"page":"23-27","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Atypical cutaneous findings of\n                    <scp>hand\u2010foot\u2010mouth<\/scp>\n                    disease in children: A systematic review"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5166-1883","authenticated-orcid":false,"given":"Samantha Y.","family":"Starkey","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"},{"name":"Nemours Children's Hospital Delaware  Wilmington Delaware USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristie","family":"Mar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Khaslavsky","sequence":"additional","affiliation":[{"name":"Vancouver General Hospital  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darshana","family":"Seeburruth","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Khalid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Virmani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"},{"name":"Island Infectious Disease Consultants  Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7808-3369","authenticated-orcid":false,"given":"Joseph M.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Skin Science University of British Columbia  Vancouver British Columbia Canada"},{"name":"BC Children's Hospital  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1058-9413","authenticated-orcid":false,"given":"Ilya","family":"Mukovozov","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Skin Science University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1743-422X-10-209"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00430-016-0465-y"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1509.090438"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70264-0"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1099\/vir.0.000062"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.12871"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-2915"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00105-019-4452-2"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3175"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit383"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30566-3"},{"key":"e_1_2_7_13_1","unstructured":"OCEBM Levels of Evidence Working Group.The Oxford 2011 Levels of Evidence. 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