Cutaneous lesions with a starry-sky pattern: the polymorphism of the hand-foot-and-mouth disease

The exanthematic diseases usually have a typical defined pattern that facilitates the clinical diagnosis, although occasionally doubts arise due to similarity of pathologies and it is necessary to know the etiological agent. The Hand-foot-and-mouth disease has always been one of the easiest pathologies to be recognized for its classic skin and mucous involvement; however, nowadays there has been a change in the distribution, extension and morphology of lesions, which give it great simulation capacity. In cases where the clinical manifestation is atypical and a wrong labeling can deprive a patient from chickenpox vaccine, serology can be useful. We present a case of atypical Hand-foot-and-mouth disease in a patient without previous dermopathy.