From the Guidelines
No, Hand, Foot, and Mouth Disease (HFMD) does not cause erythema marginatum. HFMD typically presents with fever, sore throat, and characteristic painful vesicular lesions on the hands, feet, and in the mouth. The rash in HFMD consists of small red spots that often develop into blisters, primarily on the palms, soles, and oral mucosa. Erythema marginatum, on the other hand, is a distinctive rash characterized by pink or red rings with clear centers and wavy edges that appear mainly on the trunk and inner surfaces of the limbs, as described in the revised Jones criteria for the diagnosis of acute rheumatic fever 1. It is most commonly associated with acute rheumatic fever, not viral infections like HFMD. Erythema marginatum occurs due to an autoimmune response following Group A Streptococcal infections, while HFMD is caused by enteroviruses, most commonly coxsackievirus A16 and enterovirus 71. The pathophysiology and appearance of these two conditions are distinctly different, and they should not be confused in clinical diagnosis, as emphasized in the guidelines for the diagnosis of acute rheumatic fever 1. Key points to consider in differentiating these conditions include:
- The characteristic locations and appearances of the rashes
- The underlying causes of the diseases (Group A Streptococcal infections for erythema marginatum and enteroviruses for HFMD)
- The association of erythema marginatum with acute rheumatic fever, as outlined in the revised Jones criteria 1.
From the Research
Hand, Foot, and Mouth Disease (HFMD) and Erythema Marginatum
- HFMD is a viral illness caused by human enteroviruses and coxsackieviruses, characterized by a low-grade fever, a maculopapular or papulovesicular rash on the hands and soles of the feet, and painful oral ulcerations 2.
- The differential diagnosis for childhood rashes and oral enanthems is broad and includes erythema multiforme, herpes, measles, and varicella 2.
- However, there is no direct evidence in the provided studies that links HFMD to erythema marginatum, a rash characterized by a distinctive ring-shaped lesion.
- HFMD can be associated with neurologic or cardiopulmonary complications, and can rarely lead to death 3, 4, 5.
- The current understanding of HFMD suggests that it may be associated with potentially fatal neurological complications, as well as severe cardiopulmonary complications 5, 6.
- Despite the severity of some HFMD cases, there is no specific mention of erythema marginatum as a complication or associated condition in the provided studies.
- It is essential to note that the diagnosis of HFMD is usually clinical, and health professionals should be well-informed about the clinical features and the course of the disease to provide appropriate care and prevent outbreaks 3.