Hand-Foot-and-Mouth Disease (HFMD)

Hand-foot-and-mouth disease (HFMD) is a febrile disorder usually caused by coxsackievirus A16, enterovirus 71, or other enteroviruses. Infection causes a vesicular eruption on the hands, feet, and oral mucosa. Atypical HFMD due to coxsackievirus A6 often causes high fever with papulovesicular lesions progressing to vesicobullous lesions and bullae that are widely distributed on the body.

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 buttocks or genitals; usually, the vesicles of typical HFMD are benign and short-lived.

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 vesic... 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 vesic... 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 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. Aseptic meningitis may complicate atypical HFMD, but most patients recover uneventfully.

Infection with EV-71 may be accompanied by severe neurologic manifestations (eg, meningitis, encephalitis, polio-like paralysis). Morbidity and mortality are significantly higher with EV-71 than with coxsackievirus A16 or other enteroviruses. A recent cluster EV-71-associated neurologic disease was noted in the United States in 2018 (1, 2).

The diagnosis of HFMD is usually made clinically.

Treatment of HFMD is symptomatic. It includes meticulous oral hygiene (using a soft toothbrush and salt-water rinses), a soft diet that does not include acidic or salty foods, and topical measures (see treatment of stomatitis).

Three inactivated EV-71 vaccines are currently available in China, but none are yet approved for use in the United States. Coxsackie A16 vaccines are also in preclinical development.