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Hand, foot and mouth disease pathology

Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.

Hand, foot and mouth disease is a viral illness caused by coxsackievirus A16 and enterovirus 71.

Histology of hand, foot and mouth disease

Hand, foot and mouth disease is rarely biopsied.

Sections usually show acral skin with a lymphocytic infiltrate which infiltrates the epidermis (figure 1). The infiltrate is associated with keratinocyte apoptosis in early lesions (figure 2). Figure 3 shows a high power view of a more established lesions: there is papillary dermal oedema (lower half of the field), epidermal necrosis, dyskeratosis, and intraepidermal vesiculation as a consequence of epidermal oedema.

Special studies for hand, foot and mouth disease

PCR studies can be performed on tissue blocks for identification of coxsackievirus A16 and enterovirus 71.

Differential diagnosis of hand, foot and mouth disease pathology

Erythema multiforme – Early lesions of hand, foot and mouth disease can look very similar to erythema multiforme. Clinical correlation can be very helpful.

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