Hand foot and mouth disease

Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1998. Updated by Jannet Gomez; Dr Amanda Oakley, October 2016.

What is hand foot and mouth disease?

Hand foot and mouth disease (HFM) is a common mild and short-lasting viral infection most often affecting young children. It is characterised by blisters on the hands, feet and in the mouth. The infection may rarely affect adults.

Hand foot and mouth disease is also called enteroviral vesicular stomatitis.

More images of hand, foot and mouth disease ...

What is the cause of hand-foot-and-mouth disease?

Hand-foot-and-mouth is due to an enterovirus infection, usually Coxsackie virus (CV) A16. Other viruses causing HFM include:

Who gets hand foot and mouth disease?

HFM most often infects children under the age 10, and most are under 5 years of age (95%). It can uncommonly affect adults, and tends to be more severe in the elderly, immunocompromised, and pregnant women.

Hand foot and mouth disease is very infectious, so several members of the family or a school class may be affected. Epidemics are most common during the late summer or autumn months.

What are the clinical features of hand, foot and mouth disease?

Typical HFM causes:

Atypical hand foot and mouth disease results in a more widespread rash. Features may include:

Flat pink patches on the dorsal and palmar surfaces of the hands and feet are soon followed by small elongated greyish blisters. These resolve by peeling off within a week, without leaving scars.  

Usually there are also a few small oral vesicles and ulcers. These are sometimes painful, so the child eats little and frets. There may be a few on the skin around the mouth. In young children a red rash may develop on the buttocks and sometimes on the arms.

Atypical hand foot and mouth disease due to Coxsackie A6 results in a more widespread rash, larger blisters and subsequent skin peeling and/or nail shedding.

How is hand-foot-and-mouth disease diagnosed?

The diagnosis is typically made clinically, due to the characteristic appearance of blisters in typical sites, ie, hands, feet, and mouth. 

In ill children, blood tests may show:

Skin biopsy of a blister shows the characteristic histopathologic findings of hand-foot-and-mouth disease.

How is the infection transmitted?

Hand foot and mouth is passed on by direct contact with the skin, nasal and oral secretions of infected individuals, or by faecal contamination.

How is hand-foot-and-mouth disease treated?

Specific treatment is not often necessary. 

Intravenous immunoglobulin and milrinone have shown some efficacy in a few reports. 

No vaccines or specific antiviral medications are available.

Does the child have to stay off school?

As in the vast majority of cases hand foot and mouth disease is a mild illness, there is no need to keep children from school once they are well enough to attend.

The blisters remain infective until they have dried up, which is usually within a few days. The stools are infective for up to a month after the illness. Thorough hand-washing will reduce the spread of the disease.

What are the complications of hand-foot and mouth disease?

Complications are uncommon. They include:

 Serious enteroviral infection can lead to:

Neurological involvement associated with enterovirus 71 infection may include:

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