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Hand, Foot, and Mouth Disease

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor
    Melissa Conrad Stöppler, MD, Chief Medical Editor

    Melissa Conrad Stöppler, MD, Chief Medical Editor

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Hand, Foot, and Mouth Disease Related Articles

What is Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease 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.)

What Causes 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 an 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.

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

What are Symptoms and Signs of Hand, Foot, and Mouth Disease?

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 and pains, etc.).

These symptoms generally last one to two days before a blister-like rash develops on the hands, feet, and in the 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, other more serious complications occur, including viral meningitis (aseptic meningitis) and encephalitis. The symptoms associated with these complications include

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

When Should I Call the Doctor about Hand, Foot & Mouth Disease?

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

How Is Hand, Foot, and Mouth Disease Diagnosed?

There are no tests indicated in obvious cases of hand, foot, and mouth disease. The diagnosis is made based upon 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.

What Is the Treatment for Hand, Foot, and Mouth Disease?

There is no specific treatment for hand, foot, and mouth disease. Supportive care, including fever management, and prevention of dehydration are the primary goals. 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 health-care provider.

Is There a Hand, Foot, and Mouth Disease Vaccine?

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.

Are There Diseases That Mimic Hand Foot and Mouth Disease?

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 health-care provider, since the management of the three illnesses differs slightly.

Hand, Foot, and Mouth Disease Treatment

There is no specific treatment for hand, foot, and mouth disease. Supportive care, including fever management, and prevention of dehydrationare the primary goals. Occasionally, "magic mouthwash" is prescribed by the provider. This is a mix of several oral liquid medications, generally including a topical anesthetic and 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.

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Reviewed on 11/1/2018
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