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Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Children's health is focused on the well-being of children from conception through adolescence.
Non-polio enteroviruses cause a variety of infections, including aseptic meningitis, hand, foot, and mouth disease, herpangina, and the common cold. Hand, foot, and mouth disease (HFMD) is a highly contagious disease caused by several enteroviruses. Sign up to stay informed with the latest children's health and parenting related updates on MedicineNet delivered to your inbox FREE!
Over a two-month period, a 52-year-old woman developed bilateral nonpruritic blisters (Figure 1) and fragile skin, localised to the dorsal surfaces of her hands. The differential diagnosis of acral blisters and skin fragility includes the following conditions.Epidermolysis bullosa is a heterogeneous group of inherited disorders that are characterised by mutations in adhesion molecules or anchoring fibrils that bind the skin.

Porphyria cutanea tarda presents in an identical clinical and histological pattern to that seen in this case. Pseudoporphyria may also be seen in acral areas in individuals who have chronic renal failure, with or without dialysis, and in those with chronic sun damage or chronic UV exposure via tanning beds. Removal of the offending agent usually results in slow resolution of the blisters over several months. Associate Professor Kossard is Director of Dermatopathology at the Skin & Cancer Foundation Australia, Darlinghurst, Sydney, NSW. It is associated with elevated porphyrins produced by the liver, which can be tested by quantitating urinary porphyrins. A careful drug history and a history of exposure to sunlight or artificial light are important in reaching a diagnosis. Mild forms may present as fragile skin with superficial blisters of the feet and hands, particularly the soles and palms.

It may be induced by a variety of drugs, including naproxen, nalidixic acid, tetracyclines, frusemide and retinoids.
Other nonsteroidal anti-inflammatory drugs, such as diclofenac, indomethacin or COX-2 inhibitors, may be substituted for naproxen. Skin biopsy may show dissolution of basal keratinocytes due to abnormalities in keratin tonofilaments, important in keratinocyte adhesion structures in the basal layer. Skin immunofluorescence reveals linear deposits of immunoglobulins along the basement membrane zone.

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