Hand, Foot, and Mouth Disease

Picture of characteristic rash and blisters of the hand, foot, and mouth disease (HFMD)

Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by a virus. The illness most often occurs in the spring and fall and is most frequently seen in young children, infants, and toddlers. It is characterized by fever and a blister-like rash affecting the palms of the hands and soles of the feet along with blisters inside the mouth. (It is unrelated to foot and mouth disease, which affects livestock.)

• Hand, foot, and mouth disease is generally caused by coxsackievirus A-16, which is a member of the enterovirus family.
• The initial symptoms include fever and general malaise (poor appetite, aches, and pains, etc.).
• Supportive care, including fever management, and prevention of dehydration are the primary goals.
• There is no vaccine for HFMD
• Hand, foot, and mouth disease can be confused with other viral causes of oral ulcers and blisters.

Picture of characteristic rash and blisters of hand foot and mouth disease

• Hand, foot, and mouth disease is generally caused by coxsackievirus A-16, which is a member of the enterovirus family.
• There are other types of enteroviruses that can cause the symptoms as well, but these are less common.

Children usually become infected with the virus from other children in a fecal-oral pattern; that is, infection is acquired from exposure to infected fecal material or oral secretions (nasal discharge, saliva, etc.).

The incubation period (time between exposure and symptoms) is usually five days.

Hand, foot, and mouth disease usually occurs in the spring and fall seasons but may occur at any time during the year. The initial symptoms include

• fever and
• general malaise (poor appetite, aches, pains, etc.).

These symptoms generally last one to two days before a blister-like rash develops on the hands, feet, and mouth. The rash initially appears as small red spots but then develops into vesicles (blisters). The blisters may develop on the gums, inner cheeks, and tongue, and patients may complain of mouth pain and a sore throat. These young patients tend to drool and avoid swallowing and may refuse to drink or eat because of the discomfort. Very young infants may even become dehydrated due to the refusal to drink.

Rarely, do other more serious complications occur, including viral meningitis (aseptic meningitis) and encephalitis. The symptoms associated with these complications include

• high fever,
• headache,
• lethargy,
• irritability,
• stiff neck, and
• back pain.

If your child has any of these additional symptoms, you should seek medical attention.

Any high fever in a very young infant should be evaluated by a healthcare practitioner. For older infants and children, as long as the child has adequate oral intake, this particular illness can be managed comfortably at home.

There are no tests indicated in obvious cases of hand, foot, and mouth disease. The diagnosis is made based on the typical symptoms and signs found upon examination. This is due to the fact that the diagnostic laboratory tests that are available generally take two to three weeks to get results, and generally, the symptoms of the illness will have resolved already by this time.

There is no specific treatment for hand, foot, and mouth disease. Supportive care, including

• fever management, and
• prevention of dehydration is the primary goal.

Occasionally, "magic mouthwash" is prescribed by the provider. This is a mix of several oral liquid medications, generally including a topical anesthetic and diphenhydramine (Benadryl). This is then applied to the mouth ulcers to decrease the pain associated with the oral lesions, decrease the inflammatory response, and encourage the affected infant to increase oral intake.

If your child's fever remains elevated despite appropriate fever-reducing drugs, or if he/she develops any signs or symptoms of

• dehydration (dry skin and mucous membranes, weight loss, persistent irritability, lethargy, or decreased urine output), you should seek immediate medical attention.

Obviously, when concerned or in doubt, contact your child's healthcare provider.

Appropriate infection control practices are recommended to prevent the spread of hand, foot, and mouth disease. Good hand hygiene (washing hands) is always important. Children infected with the virus causing hand, foot, and mouth disease generally have mild illness and recover within one week of developing symptoms.

There is no vaccine; however, the illness is typically mild and self-limited, and children generally cannot develop the illness twice. In addition, most adults have persistent immunity and cannot become infected either.

Hand, foot, and mouth disease can be confused with other viral causes of oral ulcers and blisters.

Herpetic gingivostomatitis and herpangina are the conditions most commonly confused with hand, foot, and mouth disease. Differentiation is usually based on the fever history, the presence and appearance of the rash, and the location of the oral ulcers. Herpangina is caused by a number of different viruses and differs from hand, foot, and mouth disease in that the oral ulcers generally affect the posterior pharynx (back of the throat, uvula, tonsils, and posterior palate) and spare the anterior pharynx (gingiva, inner lips, cheeks, tongue), and the rash, if present, does not affect the palms and soles.

Herpetic gingivostomatitis caused by HSV1 generally affects the anterior pharynx but is not associated with a rash on the palms and soles. Lastly, both herpangina and herpetic gingivostomatitis are associated with high fever, while hand, foot, and mouth disease generally is associated with a low-grade fever. If you are concerned, consult your healthcare provider, since the management of the three illnesses differs slightly.