Bullous Hand-Foot-and-Mouth Disease

Abstract

Hand, foot and mouth disease is a viral exanthema that typically occurs during summer and autumn, characterized by oral erosions and papulovesicular lesions on the palms and soles. It is most commonly caused by enteroviruses, including coxsackievirus 16 and enterovirus 71. Atypical forms – frequently associated with coxsackievirus A6 – present with more widespread papulovesicles, vesicles, and erosions involving the palms, soles, extremities, and perioral region, and may also include unusually large bullae. We present the case of a 2-year-old girl with papulovesicles, vesicles, and bullae on erythematous-exudative plaques on the inner thigh, accompanied by confluent erosions and small perioral vesicles. Fever preceded the eruption by one day and intense pruritus was prominent. This case underscores the importance of recognizing bullous hand, foot and mouth disease as a clinical variant that can mimic other vesiculobullous dermatoses.