{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T12:57:18Z","timestamp":1791118638156,"version":"4.1.0"},"reference-count":38,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)\u2013associated North American enterovirus outbreak of 2011\u20132012.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Eighty patients were included in this study (median age 1.5 years, range 4 months\u201316 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving &amp;gt;10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed \u201ceczema coxsackium.\u201d Other morphologies included Gianotti-Crosti\u2013like (37%), petechial\/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2012-3175","type":"journal-article","created":{"date-parts":[[2013,6,18]],"date-time":"2013-06-18T00:50:57Z","timestamp":1371516657000},"page":"e149-e157","source":"Crossref","is-referenced-by-count":232,"title":["\u201cEczema Coxsackium\u201d and Unusual Cutaneous Findings in an Enterovirus Outbreak"],"prefix":"10.1542","volume":"132","author":[{"given":"Erin F.","family":"Mathes","sequence":"first","affiliation":[{"name":"Departments of Dermatology, and"},{"name":"Pediatrics, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash","family":"Oza","sequence":"additional","affiliation":[{"name":"Departments of Dermatology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona J.","family":"Frieden","sequence":"additional","affiliation":[{"name":"Departments of Dermatology, and"},{"name":"Pediatrics, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Cordoro","sequence":"additional","affiliation":[{"name":"Departments of Dermatology, and"},{"name":"Pediatrics, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeo","family":"Yagi","sequence":"additional","affiliation":[{"name":"State of California, Department of Public Health, Richmond, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Howard","sequence":"additional","affiliation":[{"name":"Departments of Dermatology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Kristal","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Stony Brook University, Stony Brook, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine C.","family":"Ginocchio","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System Laboratories, Lake Success, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Schaffer","sequence":"additional","affiliation":[{"name":"Departments of Dermatology, and"},{"name":"Pediatrics, New York University School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheilagh","family":"Maguiness","sequence":"additional","affiliation":[{"name":"Pediatric Dermatology, Children\u2019s Hospital Boston, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Bayliss","sequence":"additional","affiliation":[{"name":"Divisions of Dermatology, Pediatrics and Internal Medicine, Washington University School of Medicine, St. Louis Children\u2019s Hospital, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Lara-Corrales","sequence":"additional","affiliation":[{"name":"Dept of Pediatrics, Division of Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Garcia-Romero","sequence":"additional","affiliation":[{"name":"Dept of Pediatrics, Division of Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Kelly","sequence":"additional","affiliation":[{"name":"Pediatrics Private Practice, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Salas","sequence":"additional","affiliation":[{"name":"State of California, Department of Public Health, Richmond, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Steven","family":"Oberste","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Allan","family":"Nix","sequence":"additional","affiliation":[{"name":"Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Glaser","sequence":"additional","affiliation":[{"name":"State of California, Department of Public Health, Richmond, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Antaya","sequence":"additional","affiliation":[{"name":"Dermatology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,7,1]]},"reference":[{"issue":"12","key":"2021120900124797400_B1","first-page":"213","article-title":"Notes from the field: severe hand, foot, and mouth disease associated with coxsackievirus A6\u2014Alabama, Connecticut, California, and Nevada, November 2011\u2013February 2012.","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"9","key":"2021120900124797400_B2","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.3201\/eid1509.090438","article-title":"Coxsackievirus A6 and hand, foot, and mouth disease, Finland.","volume":"15","author":"Osterback","year":"2009","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"2021120900124797400_B3","doi-asserted-by":"crossref","first-page":"E110","DOI":"10.1111\/j.1469-0691.2012.03789.x","article-title":"Outbreak of hand, foot and mouth disease\/herpangina associated with coxsackievirus A6 and A10 infections in 2010, France: a large citywide, prospective observational study.","volume":"18","author":"Mirand","year":"2012","journal-title":"Clin Microbiol Infect"},{"issue":"pt 3","key":"2021120900124797400_B4","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1099\/jmm.0.036400-0","article-title":"Circulation of multiple enterovirus serotypes causing hand, foot and mouth disease in India.","volume":"61","author":"Gopalkrishna","year":"2012","journal-title":"J Med Microbiol"},{"issue":"12","key":"2021120900124797400_B5","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.3201\/eid1712.110395","article-title":"Enterovirus co-infections and onychomadesis after hand, foot, and mouth disease, Spain, 2008.","volume":"17","author":"Bracho","year":"2011","journal-title":"Emerg Infect Dis"},{"issue":"4","key":"2021120900124797400_B6","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jmii.2011.01.031","article-title":"Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009.","volume":"44","author":"Lo","year":"2011","journal-title":"J Microbiol Immunol Infect"},{"issue":"1","key":"2021120900124797400_B7","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jcv.2010.02.002","article-title":"Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland.","volume":"48","author":"Blomqvist","year":"2010","journal-title":"J Clin Virol"},{"issue":"2","key":"2021120900124797400_B8","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3201\/eid1802.111147","article-title":"Hand, foot, and mouth disease caused by coxsackievirus A6, Japan, 2011.","volume":"18","author":"Fujimoto","year":"2012","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"2021120900124797400_B9","doi-asserted-by":"crossref","first-page":"e1076","DOI":"10.1016\/j.ijid.2010.07.006","article-title":"The largest outbreak of hand; foot and mouth disease in Singapore in 2008: the role of enterovirus 71 and coxsackievirus A strains.","volume":"14","author":"Wu","year":"2010","journal-title":"Int J Infect Dis"},{"issue":"10","key":"2021120900124797400_B10","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.3201\/eid1810.120813","article-title":"Hand, foot, and mouth disease caused by coxsackievirus a6.","volume":"18","author":"Flett","year":"2012","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"2021120900124797400_B11","doi-asserted-by":"crossref","first-page":"e52073","DOI":"10.1371\/journal.pone.0052073","article-title":"Circulation of Coxsackievirus A10 and A6 in hand-foot-mouth disease in China, 2009-2011.","volume":"7","author":"Lu","year":"2012","journal-title":"PLoS ONE"},{"issue":"8","key":"2021120900124797400_B12","first-page":"615","article-title":"Report of an outbreak of febrile illness with pharyngeal lesions and exanthem: Toronto, summer 1957; isolation of group A Coxsackie virus.","volume":"79","author":"Robinson","year":"1958","journal-title":"Can Med Assoc J"},{"issue":"4","key":"2021120900124797400_B13","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1542\/peds.37.4.637","article-title":"Hand, foot, and mouth syndrome. 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