Hand, foot, and mouth disease

What are the causes of foot, hand, and mouth illness?

Hand, foot, mouth, and illness (HFMD and HFM) is a prevalent, self-limiting, viral disease that causes blisters on the feet, hands, and around your mouth. It is most prevalent among children who are younger than five years.

HFMD, also called enteroviral or vesicular Stomatitis, is seen sporadically across the globe. Epidemics are more common during warm weather, generally in the latter part of summer or the early autumn.

It is crucial to remember that HFMD is not a sign of foot and mouth disease in animals.


Who is affected by foot, hand, and mouth diseases?

HFMD is most common in children who are less than ten years old. Age, 90% of cases occur among toddlers under five years old. However, it can also affect older children/adolescents. Adults, specifically the ones who’re immunocompromised, might also be affected. Yet, HFMD only rarely affects healthy adults.

Hand, mouth, foot, and illness are quite frequent. The annual average rate of HFMD is reported as being between 90 and 2000 cases per 100,000 in certain countries.

What is the cause of foot, hand, and mouth diseases?

Coxsackie Virus brings on Enteroviral Vesicular Stomatitis (HFMD), typically the A16 subtype. It can cause other infections, such as:

  • Coxsackie A virus (5, 6, 7, 9, 10)
  • Coxsackie B virus (2, 5)
  • Enterovirus 71
  • Echoviruses.

Enterovirus 71 is often associated with more severe infections that may affect the lungs and heart and trigger irritation of the brain’s lining ( meningitis).

Transmission is caused by direct contact with the blister liquid or droplets traveling through the mouth. It can spread quickly in the family or the school. The virus is released in feces or saliva for some time.

What are the clinical signs of foot, hand, and mouth diseases?

The symptoms typically begin with all symptoms: fever or sore throat, lack of appetite, and fatigue. Yet, a lot of children remain at peace despite the eruption. The blisters typically appear within 2 to 3 days after the fever.

The incubation period is believed to last 3-7 days typically, and children are uninfected until the blisters rupture and heal (usually 7-10 days).

Standard skin tests include:

  • Abrasions on tops of palms, feet, hands, and soles. Lesions usually:
    • Feel tender
    • Change over time in a series of steps, from pink flat macules to tiny blisters that are red-greyish, elongated, and elongated.
    • They are usually oval rather than round.
    • Peel off the skin within one week, leaving behind a mark.
  • Small, swollen blisters ( vesicles) and ulcers could form within and around the mouth and lips and the rear of the throat. These are often painful. Food intake can be significantly affected, particularly in children and infants.
  • For children suffering from eczema or previous eczema, blisters, macules, and papules can appear on other skin areas, including the buttocks and occasionally on the legs, arms, and genital skin.

An atypical HFMD could cause an even more general skin rash and blisters. The features could include:

  • A red, and crusted papules, macules that do not blister.
  • Large blisters (bulla)
  • Targetoid (bulls-eye or target-shaped) lesions
  • Nail shedding
  • The involvement of unusual or atypical places like the ears.
Foot, hand, and mouth diseases

Hand, foot, and mouth disease

Stomatitis in HFMD

Oval blisters on the sole of hand, foot, and mouth disease

Nail changes noted six weeks after hand and mouth blister resolution

Oral hand, foot, and mouth


What are the differences in clinical features among different kinds of skin?

In patients with pre-existing eczema (atopic dermatology), HFMD lesions may be found in eczematous zones (eczema coxsackie).

What are the ramifications of foot, hand, and mouth diseases?

Infrequent are serious complications for people who have a healthy lifestyle. These include:

  • Insufficient intake of fluids. This can lead to serious health issues for young children.
  • Toenail and fingernail changes tend to be noticed around two months following HFMD infections caused by coxsackie infection.
    • Transverse lines inside the nail plate that gradually move outwards
    • Onychomadesis (nail shed) can occur around two months following the onset of illness; however, in the end, it will pass, and the nails will return to normal.

An enteroviral severe infection may cause:

  • Widespread blistering
  • Enteritis
  • Myocarditis
  • Inflammation of the brain and or the lining of the brain (meningoencephalitis)
  • Loss of nerve function in a limb (acute flaccid paralysis)
  • Pneumonia and Oedema Oedema and pneumonia
  • Hemorrhagic conjunctivitis
  • During pregnancy, infections that create HFMD may cause the first trimester to have a spontaneous miscarriage or an intrauterine growth restriction.
  • Meningoencephalitis, thrombocytopenia, dissemin cardiomyopathy, intravascular coagulopathy, and hepatitis in infants are rarely described.

What are the signs of foot, hand, and mouth disease treated?

HFMD is typically diagnosed by a clinical. The cutaneous lesions usually occur uniformly over familiar places of the skin, such as the feet, hands, and in and around the mouth of children.

Other diagnostic tools are:

  • Polymerase chain reaction ( PCR ) testing
    • The virus DNA can be detected in the nasopharyngeal (throat or nose) Swabs, stool, and other samples.
    • The analysis of blood-cerebrospinal liquid (CSF) and feces can verify the diagnosis. However, they are seldom required, except for atypical or extreme instances.
  • Skin biopsy of an erupting blister
    • Rarely mentioned.
    • The skin is acral. Acral skin that has lymphocytic infiltrates on the epidermis.
    • This Infiltrate is linked to keratinocyte Apoptosis in the early stages of lesions.


What’s the differentiating diagnosis for foot, hand, and mouth diseases?

  • Bacterial infections, like Group A Streptococcus and Staphylococcus aureus, can cause similar skin lesions that blister, such as impetigo bullous.
  • Other infections that are viral, such as human parechoviruses and herpes simplex virus, adenoviruses zoster virus and Epstein-Barr virus, as well as human herpesvirus 6 and 7.
  • The abrasive reactions to insect bites could also appear on the feet and hands when children are around.
  • Pompholyx eczema.

What are the treatments for foot, hand, and mouth diseases?

Treatment is not typically needed for HFMD The primary treatment is usually symptomatic. HFMD rarely results in serious complications. Antibiotics don’t work, so they should never be prescribed to children suffering from HFMD.

There are no vaccines or specific antiviral medicines available.

General measures

Pain relief

  • Essential analgesias like paracetamol and Ibuprofen when necessary.
  • Antiseptic toothpaste and topical comforting agents (e.g., lignocaine, e.g.) are a good option for children who suffer from painful oral/palatal ulcers.
  • Aspirin shouldn’t be used frequently due to the risk associated with Reye syndrome.


  • Make sure to offer your child regular sips of juice or water to avoid dehydration.
  • When oral intake appears not optimal, Nasogastric or intravenous fluids might be suggested.

Blister care

  • Let the blisters dry naturally.
  • Avoid piercing or breaking the blisters to prevent spreading.
  • Clean the blisters by applying non-adherent dressings to the eroding areas.

Children with foot, hand, and mouth diseases stay away from school?

In most instances, HFMD is a mild illness, and there is no reason to exclude children from school when they are healthy enough to attend.

The blisters are infected until they dry, which usually takes several days. The virus is shed via fecal stool and remains infected for as long as one month following the onset of infection. Therefore, keeping children at a distance from school is not practical.

General preventative measures comprise:

  • A thorough hand hygiene routine is recommended, particularly after contact with bodily fluids.
    • This could include the touch of their blisters, assisting them to blow their noses, changing nappies, and aiding with toileting.
  • Reduce sharing of personal items like drinking cups, cutlery towels, toothbrushes, and clothes.

What happens to foot, hand, and mouth illnesses?

HFMD, the disease is usually minimal, and full resolution is evident after 7 – 10 days. Infections often result in long-lasting immunity against the specific virus, but a subsequent episode may occur after an infection with another member of the Enterovirus group.


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