Hand, foot and mouth disease: is it time for an update?

This article focuses on the observed increase and evolving clinical presentation of hand, foot and mouth disease (HFMD) in pediatric inpatients at a level 4 hospital in Ireland. Traditionally caused by coxsackievirus A16 and enterovirus 71, HFMD is now increasingly linked to the coxsackievirus A6 strain, which produces atypical, more extensive rashes including larger vesicles, bullae, perioral eruptions, and napkin dermatitis, especially in children under five. The authors highlight a rise in HFMD-related dermatology consultations from 0% in 2012 to 43% in 2023 and advocate for updating public and healthcare information to reflect these atypical presentations to improve recognition, management, and prevention of transmission.