What are the symptoms and treatment options for hand, foot, and mouth disease?

Symptoms of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is characterized by fever, sore throat, and a distinctive rash on the hands, feet, and in the mouth, typically resolving within 7-10 days without specific treatment. 1

Clinical Presentation

Initial Symptoms

• Low-grade fever (typically 39-40°C/102-104°F)
• Malaise and fatigue
• Sore throat
• Reduced appetite

Characteristic Rash and Lesions

The rash typically appears 1-2 days after fever onset and follows this pattern:

• Oral lesions: Painful ulcerations in the mouth, often on the tongue, gums, and inside of cheeks
• Skin rash: Initially appears as maculopapular lesions that evolve into vesicular eruptions
• Distribution: Primarily affects:
  • Palms of hands
  • Soles of feet
  • May also involve buttocks and groin areas 1

Timeline and Progression

1. Fever appears first
2. Characteristic rash develops within 1-5 days after fever onset
3. Complete resolution typically occurs within 7-10 days 1

Less Common Manifestations

• Nail dystrophies (e.g., Beau's lines or nail shedding) may appear weeks after initial symptoms 2
• In atypical cases, vesiculobullous exanthema may appear on the trunk or extremities 3
• Perioral zone involvement has been reported in cases caused by Coxsackievirus A6 3

Complications

While HFMD is typically mild and self-limiting, rare complications can occur:

• Neurological complications (encephalitis, meningitis)
• Pulmonary edema
• Myocarditis 3

These severe complications are more common in children but can occasionally affect adults as well.

HFMD in Adults

Although HFMD primarily affects children under 5 years of age, it can occur in adults:

• Adult cases often present with similar symptoms to children
• The disease is typically self-limiting in immunocompetent adults 4, 5
• Familial transmission from children to adults has been documented 5

Causative Agents

HFMD is caused by enteroviruses, most commonly:

• Coxsackievirus A16 (traditional most common cause in the US)
• Enterovirus 71
• Coxsackievirus A6 (increasingly common) 2, 3

Differential Diagnosis

HFMD should be distinguished from:

• Kawasaki Disease (rash without vesicles, often with perineal accentuation)
• Rocky Mountain Spotted Fever (rash begins as macules on extremities, evolves to petechiae)
• Diaper rash (when HFMD affects the diaper area) 1

Treatment

No specific antiviral treatment is available for HFMD. Management focuses on:

• Symptomatic relief
• Adequate hydration
• Pain management for oral lesions
• Prevention of complications 1, 6

Prevention

• Proper hand hygiene, especially before and after diaper changes
• Disinfection of potentially contaminated surfaces
• Isolation during the acute phase of illness 1

HFMD is highly contagious, with outbreaks typically occurring during summer and autumn months in the United States 2.