Hand-Foot-and-Mouth Disease (HFMD)

The disease is most common among young children. The course is similar to that of herpangina. (See also Overview of Enterovirus Infections.)

Children have a sore throat or mouth pain and may refuse to eat. Fever is common. Vesicles are distributed over the buccal mucosa and tongue, the palms of the hands and soles of the feet, and, occasionally, the perianal/perineal diaper area; usually, the vesicles of typical HFMD are painful, but benign and short-lived (1).

Manifestations of Hand-Foot-and-Mouth Disease

Hand-Foot-and-Mouth Disease (Oral and Facial Lesions)

This photo shows vesicles on the tongue and around the mouth in a patient with hand-foot-and-mouth disease.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Hand-Foot-and-Mouth Disease (Oral Lesions)

This photo shows oral lesions that appear as various-sized erosions and ulcerations on an erythematous base after vesicles have opened.

... read more

© Springer Science+Business Media

Hand-Foot-and-Mouth Disease (Hand Lesions)

This photo shows vesicles on the palm surrounded by erythema.

© Springer Science+Business Media

Hand-Foot-and-Mouth Disease (Foot Lesions)

This photo shows vesicles and erythematous papules on the sole of a patient with hand-foot-and-mouth disease.

SCIENCE PHOTO LIBRARY

Coxsackie Virus A Exanthem (Foot Lesions)

This image shows a clear-filled vesicle on the toe of a child with hand-foot-and-mouth disease.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Hand-Foot-and-Mouth Disease (Oral and Facial Lesions)

This photo shows vesicles on the tongue and around the mouth in a patient with hand-foot-and-mouth disease.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Hand-Foot-and-Mouth Disease (Oral Lesions)

This photo shows oral lesions that appear as various-sized erosions and ulcerations on an erythematous base after vesicles have opened.

... read more

© Springer Science+Business Media

Hand-Foot-and-Mouth Disease (Hand Lesions)

This photo shows vesicles on the palm surrounded by erythema.

© Springer Science+Business Media

Hand-Foot-and-Mouth Disease (Foot Lesions)

This photo shows vesicles and erythematous papules on the sole of a patient with hand-foot-and-mouth disease.

SCIENCE PHOTO LIBRARY

Coxsackie Virus A Exanthem (Foot Lesions)

This image shows a clear-filled vesicle on the toe of a child with hand-foot-and-mouth disease.

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Atypical HFMD may have additional features:

• Widespread vesiculobullous lesions

• Eczema coxsackium with lesions concentrated in areas of eczematous skin (2)

• 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) can occur during convalescence. Neurologic disease, such as aseptic meningitis, encephalitis, or acute flaccid myelitis (AFM), may accompany HFMD, particularly when caused by EV-A71.

Morbidity and mortality are significantly higher with EV-A71 than with other enteroviruses. A cluster of EV-A71-associated neurologic disease was noted in the United States in 2018 (3, 4).

The diagnosis of HFMD is usually made clinically.

Treatment of HFMD is symptomatic, including pain control, topical measures (see treatment of stomatitis), and hydration.

Meticulous hand hygiene, particularly surrounding diaper changes and stooling, and avoiding contact with open skin lesions and oral secretions (drool) can help limit spread. Three inactivated EV-A71 vaccines are currently available in China, but none are yet approved for use in the United States (5).