What is Hand Foot and Mouth Disease?

Dermatologic Findings

Coloured TEM of a group of Coxsackie viruses
Centers for Disease Control and Prevention / Getty Images


Hand, foot, and mouth disease (HFMD) is a common viral illness in children that is often accompanied by fevers as well as sores on the hands, feet, and inside the mouth. It is usually self-limited and requires treatment only for symptoms.

What causes Hand, Foot, and Mouth Disease?

The virus that usually causes HFMD is a member of a group of viruses within the Picornaviridae family known as the Coxsackie A viruses, also sometimes more broadly referred to as enteroviruses.

What is Hand, Foot, and Mouth Disease?

HFMD incidence often peaks in the summer and fall months. It is usually spread by direct contact of fluid secretions such as mucus, saliva, or blister fluid with other infected individuals. Though the virus is common in children under age 5, older children and adults can also get the disease from close contact with other children in school and nurseries. Symptoms first develop about 3-6 days after exposure to the virus with a fever, sore throat, or general feelings of being unwell, and the characteristic skin lesions appear 1-2 days after the onset of these symptoms.

Dermatologic Findings

  • Mouth: The sores begin as red spots a few millimeters in diameter in the mouth cavity and can be quite painful. They are found on the tongue, the roof of the mouth, inside of the cheeks, throat, and occasionally involve the lips. Over time these spots progress and form vesicles, or small fluid-filled blisters. When the vesicles lose the thin layer of skin containing the fluid underneath, they form what are known as ulcers, which are small, raw, red-white appearing areas with a deeper layer of skin exposed. Because the skin has temporarily lost its protective outer covering, these skin lesions continue to be painful and can make it difficult for children to eat or drink, particularly acidic foods such as fruit juices and tomato products, as well as spicy or salty foods.
  • Skin: There is also a skin rash that is characteristic of HFMD. It is usually found on the palms and soles of affected individuals. The rash starts as small red spots which can develop into small, fluid-filled blisters over the course of a few days. They will appear as flat or raised, pink areas with a central pallor. They can be painful. If they break open, the fluid inside of these blisters contains viral particles and can transmit the disease. They are no longer contagious when all spots crust over and heal. While the skin rash is most commonly found on the palms and soles, it can also be found around the mouth and on the buttocks, genitals, knees and elbows.
  • Nails: Yet another dermatologic manifestation of HFMD is known as onychomadesis, or separation of the nail from the nail bed. This rare manifestation has been reported several weeks after resolution of active disease symptoms in outbreaks with certain viruses.  This too usually resolves without complication.
  • More information: The disease can be variably present with these rashes. Some individuals may have a barely noticeable rash or just mouth sores while others can have much more widespread skin involvement. Taken individually, the lesions on the mouth can have the appearance of other types of rashes which your physician or healthcare provider can distinguish between.  Symptoms usually resolve on their own, and the skin rash and sores will disappear in about 7-10 days.

How is Hand, Foot, and Mouth Disease diagnosed?

A physician can usually diagnose HFMD by taking a history, performing a physical exam paying particular attention to the skin and mouth rashes, and staying informed about disease patterns in your community. No further testing is usually required.

How is Hand, Foot, and Mouth Disease treated and prevented?

Because the symptoms and rash associated with HFMD usually resolve on their own in a short time, treatment is primarily aimed at relieving discomfort and maintaining hydration.

Cold drinks and ice pops can help relieve some of the pain associated with the mouth sores and simultaneously provide hydration. Acetaminophen or ibuprofen can be used to help with pain related to the rash, sore throat, or to reduce fever. Parents of an affected child should use a gloved hand when touching any of the skin sores and may want to keep the child out of group settings for a few days until symptoms resolve.

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