Onychomadesis: A rare skin sign occurring after chickenpox

Clinical examination showed bilateral onychomadesis involving the first and third left fingernails and a single Beau's line was present in the I, II, and III toenails [Figure 1]a and [Figure 1]b. Serological testing for IgG and IgM antibodies against varicella zoster virus (VZV) and Enterovirus had been prescribed. About 8 weeks later, the patient returned for a clinical checkup, revealing the advancement of the Beau's lines between the proximal and distal portion of the nail plate in toenails and complete resolution after shedding on the fingernails [Figure 1]c and [Figure 1]d. Serology yielded only positive results for anti-VZV IgG. The "all or nothing" trend of onychomadesis suggests that the nail matrix keratinocytes may have a different vulnerability threshold. [...]the outbreaks of onychomadesis in HFMD had been facilitated by the low herd immunity against Coxsackievirus A6 and A10, considered as the major pathogens.