DR P MARAZZI / SCIENCE PHOTO LIBRARY Atypical HFMD has 4 distinct presentations: Widespread vesiculobullous lesions Eczema coxsackium with lesions concentrated in areas of eczematous skin Gianotti-Crosti type rash (multiple discrete, erythematous flat-topped papules symmetrically distributed on the face, buttocks, and extensor surface of the extremities) Purpuric lesions Onychomadesis (painless nail shedding) is common during convalescence.