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, oral lesions, and a distinctive rash on the hands, feet, and sometimes buttocks, with symptoms typically resolving within 7-10 days without specific treatment. 1

Clinical Presentation

Primary Symptoms

• Fever:

  • Low-grade fever is typically the first symptom to appear 1
  • Usually occurs 1-2 days before rash development 1

• Oral Lesions:

  • Painful ulcerations in the mouth 1
  • May affect tongue, gums, and inside of cheeks
  • Can cause sore throat and difficulty eating or drinking

• Skin Rash:

  • Appears within 1-5 days after fever onset 1
  • Begins as maculopapular lesions that evolve to vesicular eruptions 1
  • Characteristic distribution:
    • Palms of hands
    • Soles of feet
    • May also involve buttocks and groin areas 1

Additional Symptoms

• Malaise 1, 2
• Sore throat 1, 2
• Reduced appetite (due to painful oral lesions)
• Irritability in young children

Disease Progression

1. Initial Phase (Days 1-2):

   • Fever
   • Malaise
   • Sore throat

2. Eruption Phase (Days 2-5):

   • Oral lesions develop
   • Rash appears on hands, feet, and sometimes buttocks
   • Lesions evolve from maculopapular to vesicular 1

3. Resolution Phase (Days 7-10):

   • Symptoms typically resolve within 7-10 days 1
   • No specific treatment required

Special Considerations

Atypical Presentations

• Some cases may present with vesiculobullous exanthema on the trunk or extremities 3
• Perioral zone involvement has been reported, particularly with Coxsackievirus A6 infections 3
• Nail changes may occur weeks after initial symptoms, including:
  • Nail dystrophies
  • Beau's lines (horizontal ridges)
  • Nail shedding 4

Age-Related Differences

• Most common in children under 5 years 4, 5
• Can occur in adults, though less frequently 6, 3
• Adult cases may have atypical presentations but generally follow a benign course 6, 3, 2

Differential Diagnosis

HFMD should be distinguished from:

• Kawasaki Disease: presents with polymorphous exanthem without vesicles 1
• Rocky Mountain Spotted Fever: rash begins as macules on extremities evolving to petechiae 1
• Diaper rash (when lesions appear in diaper area) 1

Complications

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

• Neurological complications (rare): encephalitis, meningitis 3, 5
• Cardiopulmonary complications (very rare) 5
• Dehydration (due to painful swallowing)

Prevention

The best prevention methods include:

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

HFMD is highly contagious and can spread through:

• Direct contact with nasal secretions, saliva, fluid from blisters
• Fecal-oral route
• Respiratory droplets

Understanding these symptoms helps in early recognition and appropriate management of this common viral illness, preventing unnecessary treatments and reducing transmission.