From the Guidelines
Hand, foot, and mouth disease (HFMD) is a common and highly contagious viral illness that causes a distinctive rash, characterized by small, red spots that often develop into painful blisters, primarily on the palms of hands, soles of feet, and inside the mouth, as a result of infection with enteroviruses, such as Coxsackievirus A16 or Enterovirus 71, as noted in the study on enterovirus diagnostics and characterisation 1. The rash typically appears on the palms of hands, soles of feet, and inside the mouth, though it can also affect the buttocks, genital area, and sometimes the arms and legs. These lesions start as flat red spots that progress to fluid-filled blisters, which may eventually break open and form ulcers, particularly in the mouth. Some key points to consider about HFMD include:
- The condition is highly contagious through direct contact with an infected person's saliva, fluid from blisters, or feces, as enteroviruses are a common cause of self-limiting febrile illnesses in infants and young children, but can occasionally cause severe disease, including meningoencephalitis, myelitis, paralysis, myocarditis, sepsis-like syndrome, respiratory disease, and acute hepatitis 1.
- The rash typically develops 1-2 days after initial symptoms like fever, sore throat, and reduced appetite.
- While no specific treatment exists for the rash itself, symptoms can be managed with acetaminophen or ibuprofen for pain and fever, cold foods to soothe mouth sores, and adequate hydration.
- The rash usually resolves on its own within 7-10 days without scarring, and certain EV types, notably EV-A71, have been associated with outbreaks, occasionally resulting in significant morbidity and mortality 1.
- Handwashing and avoiding close contact with infected individuals are the best preventive measures, as certain EV types have been linked to acute flaccid myelitis (AFM) and paralysis (AFP), which involve clinical signs of rapid limb weakness with low muscle tone, and changes in the gray matter of the spinal cord demonstrated by magnetic resonance imaging (MRI) are typical for AFM cases only 1.
From the Research
Hand Foot Mouth Rash Explanation
- Hand-foot-and-mouth disease is caused by human enteroviruses and coxsackieviruses 2
- The disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles 3
- Common symptoms include:
- Low-grade fever
- Maculopapular or papulovesicular rash on the hands and soles of the feet
- Painful oral ulcerations 2
- Lesions usually resolve in seven to 10 days, but in rare cases, patients may have neurologic or cardiopulmonary complications 2
Transmission and Prevention
- Hand-foot-and-mouth disease is transmitted by fecal-oral, oral-oral, and respiratory droplet contact 2
- The best methods to prevent the spread of hand-foot-and-mouth disease are handwashing and disinfecting potentially contaminated surfaces and fomites 2
- Vaccination of susceptible individuals in high-risk areas and good personal hygiene are also important preventative measures 3
Treatment and Management
- Treatment is supportive and directed toward hydration and pain relief as needed with acetaminophen or ibuprofen 2
- Oral lidocaine is not recommended, and antiviral treatment is not available 2
- Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease 3
- Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease 3
Atypical Manifestations
- Atypical skin findings in HFMD may be seen in children with atopic dermatitis, including 'eczema coxsackium' 4
- Nail changes, such as shedding, may follow HFMD after a latency period 4
- Enterovirus 71 is responsible for epidemic outbreaks of HFMD in Asia, with systemic manifestations and occasionally neurological sequelae 4