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Salem Health: Infectious Diseases & Conditions, 2nd Edition

Hand, foot, and mouth disease

by H. Bradford Hawley, , M.D.

Category: Diseases and conditions

Anatomy or system affected: Skin

Also known as: Vesicular stomatitis with exanthem

Definition

Hand, foot, and mouth disease is an enteroviral disease that usually affects children. It causes a vesicular eruption on the hands, feet, oral mucosa, and tongue.

Causes

The disease is usually caused by coxsackie virus A16 but may also be the result of infection with a number of other coxsackie viruses, echovirus 18, and enterovirus 71.

Risk Factors

Young children, age one to five years, are most commonly infected. The most common months for infection are those in the summer and early fall. Children may become infected when they come into contact with the oral secretions of infected children during nursery school or day-care outbreaks. Skin lesions and fecal material may also contribute to the spread of the disease. It is also common to spread infection to other family members. The incubation period is three to six days.

An example of the rash caused by Hand, Foot, and Mouth virus on the palms of the hands and soles of the feet. Photo by KlatschmohnAcker via Wikimedia Commons.

Infect2e_p0492_1.jpg

Symptoms

The illness commences with a low-grade fever (100° to 101° Fahrenheit) and a sore mouth. Oral lesions begin as small red macules and rapidly evolve into fragile vesicles that rupture and leave painful ulcers. Any part of the mouth may be involved, but the hard palate buccal mucosa and tongue are mainly affected with an average of five to ten lesions. Similar lesions develop on the skin in the next one to two days and usually number twenty to thirty, but may be as many as one hundred. Discrete macular lesions, about 4 millimeters in diameter, appear on the hands and feet and sometimes the buttocks. These lesions often occur along skin lines and progress to become papules and white or gray flaccid vesicles containing infective virus. The lesions may be painful or tender, but there is no lymphadenopathy. The fever occurs during the first one to two days of the illness, which resolves in seven to ten days. Rarely, the viral infection is complicated by meningoencephalitis, carditis, or pneumonia.

Screening and Diagnosis

The diagnosis is usually made from the clinical signs and symptoms, but specimens from the mouth and skin lesions can be cultured for viruses or processed by polymerase chain reaction.

Treatment and Therapy

There is no specific treatment for hand, food, and mouth disease, which usually resolves without complications in about one week. Topical anesthetic agents, such as viscous lidocaine, may be used to soothe the discomfort of the mouth lesions.

Prevention and Outcomes

Limiting one’s contact with infected persons and handwashing after contact are the best preventive measures. Infected children’s toys and other touched objects should be cleaned with a mild bleach solution.

Further Reading

1 

Farrar, W. Edmund, et al. Infectious Diseases: Text and Color Atlas. 2d ed. New York: Gower Medical, 1992.

2 

Hosoya, M., et al. “Diagnosis of Group A Coxsackievirus Infection Using Polymerase Chain Reaction.” Archives of Diseases of Childhood 87 (2002): 316-319.

3 

Long, Sarah S., Larry K. Pickering, and Charles G. Prober, eds. Principles and Practice of Pediatric Infectious Diseases. 3d ed. Philadelphia: Churchill Livingstone/Elsevier, 2008.

4 

Modlin, John F. “Coxsackieviruses, Echoviruses, Newer Enteroviruses, and Parechoviruses.” In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, edited by Gerald L. Mandell, John F. Bennett, and Raphael Dolin. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.

Web Sites of Interest

About Kids Health

http://www.aboutkidshealth.ca

American Academy of Family Physicians

http://familydoctor.org

American Academy of Pediatrics

http://www.healthychildren.org

Centers for Disease Control and Prevention

http://www.cdc.gov

See also: Coxsackie virus infections; Echovirus infections; Enterovirus infections; Fever; Mouth infections; Skin infections.

Citation Types

Type
Format
MLA 9th
Hawley, H. Bradford. "Hand, Foot, And Mouth Disease." Salem Health: Infectious Diseases & Conditions, 2nd Edition, edited by H. Bradford Hawley, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=Infect2e_0255.
APA 7th
Hawley, H. B. (2020). Hand, foot, and mouth disease. In H. B. Hawley (Ed.), Salem Health: Infectious Diseases & Conditions, 2nd Edition. Salem Press. online.salempress.com.
CMOS 17th
Hawley, H. Bradford. "Hand, Foot, And Mouth Disease." Edited by H. Bradford Hawley. Salem Health: Infectious Diseases & Conditions, 2nd Edition. Hackensack: Salem Press, 2020. Accessed September 16, 2025. online.salempress.com.