Publish date: Posted on
Last updated: February 17, 2024
Keywords #
hand, foot, and mouth disease
coxsackievirus
enterovirus
Diagnosis #
Hand, foot, and mouth disease (HFMD) is a common viral illness marked by a papulovesicular rash on the hands and feet and painful mouth sores. The etiology of HFMD is an infection with viruses in the genus Enterovirus, the most common being Coxsackie A virus serotypes. The disease typically resolves spontaneously without complications and does not require antiviral treatment.[1]
Key Concepts #
- HFMD may be transmitted by respiratory or oral secretions, direct exposure to the fluid expressed from lesions, or the stool of infected individuals.[1]
- HFMD is common in young children but adults may also be affected.
- Treatment is supportive and lesions self-resolve within 7-10 days.[1]
- There is no vaccine to prevent this infection.
Epidemiology #
HFMD affects males and females equally. HFMD is considered a childhood illness with the largest incidence occurring in children under five years old; however, all ages may be affected.[2] Outbreaks are more common in the summer due to warmer temperatures but may occur year-round in more humid climates.[3]
Clinical Features #
- HFMD typically presents with painful mouth ulcers and may include the presence of fever, lethargy, and vomiting.
- Oral ulcers may be located on the tongue and buccal mucosa and less commonly involve the lips and tonsils.[3]
- The viral exanthem is marked by non-pruritic macules, papules, or vesicles on the dorsal or palmar/plantar surfaces and between the digits of the hands and feet. Arms, legs, and buttocks are less commonly affected.[3]
Differential Diagnoses #
- Herpangina (may be differentiated from HFMD by the absence of oral lesions on the buccal mucosa and absence of skin lesions)[1]
- Aphthous ulcers
- Herpes gingivostomatitis
- Varicella (primary varicella and varicella zoster)
- Erythema multiforme
Diagnostic Workup #
HFMD may be diagnosed clinically. If the diagnosis is unclear, the presence of enterovirus may be detected using polymerase chain reaction or serological studies.[1]
Treatment #
Treatments are mostly supportive and include relief of pain and discomfort with ibuprofen or acetaminophen. Oral lesions may be painful making it difficult to drink or swallow. We recommend monitoring for adequate liquid intake especially in children to avoid dehydration. Anti-viral medications are not necessary because the infection is self-limiting and will resolve within 7 to 10 days.[1]
