Is pruritus (itching) a typical symptom of hand, foot, and mouth disease?

Pruritus in Hand, Foot, and Mouth Disease

Yes, pruritus (itching) is a typical symptom of hand, foot, and mouth disease, particularly associated with the characteristic vesicular rash. 1, 2

Clinical Presentation of Hand, Foot, and Mouth Disease (HFMD)

• HFMD is a common viral illness primarily affecting children under 5 years of age, characterized by fever and a distinctive rash with vesicles or erosions 1
• The classic presentation includes tender lesions on the hands, feet, and oral mucosa that are often pruritic 1, 3
• Symptoms typically resolve spontaneously within a few days without complications in most cases 4

Cutaneous Manifestations and Pruritus

• The vesicular rash in HFMD is frequently accompanied by pruritus, making it one of the hallmark symptoms of the condition 2, 5
• The distribution of pruritic lesions includes:
  • Classic locations: hands, feet, and oral mucosa 1, 3
  • Extended locations: buttocks, legs, arms, and trunk in cases with widespread exanthema 2
  • Perioral region: particularly associated with Coxsackievirus A6 infections 2

Atypical Presentations with Pruritus

• In children with atopic dermatitis, HFMD may present as "eczema coxsackium," where the virus superinfects eczematous skin, causing intensely pruritic lesions that may resemble herpes infection 1, 5
• Widespread vesicular exanthema with pruritus can occur with both Coxsackievirus A6 and A16 infections 2
• Some patients may develop Gianotti-Crosti-like lesions that are typically pruritic 5

Causative Agents and Pruritus Correlation

• The most common cause of HFMD in the United States has traditionally been Coxsackievirus A16 3
• Recent outbreaks of Coxsackievirus A6 have been associated with more extensive and atypical cutaneous manifestations, often with more pronounced pruritus 2, 5
• Enterovirus 71 is responsible for epidemic outbreaks in Asia and may cause more severe systemic manifestations 1

Clinical Course and Complications

• The pruritic rash typically resolves within 7-10 days without specific treatment 1, 4
• Nail changes such as shedding (onychomadesis) may follow HFMD after a latency period of several weeks 1, 3
• In rare cases, particularly with Enterovirus 71, neurological complications may occur 4

Management of Pruritus in HFMD

• The mainstay of treatment remains supportive care, including management of pruritus 1
• Emollients may help relieve skin dryness and associated pruritus 6
• Non-sedating antihistamines may be considered for symptomatic relief of severe pruritus, though evidence for their efficacy specifically in HFMD is limited 6
• Topical treatments that help with pruritus in other conditions may be considered, though no specific recommendations exist for HFMD 6

Prevention

• Good hand hygiene and avoiding close contact with infected individuals are the primary preventive measures 4
• Research is underway to develop vaccines that could prevent HFMD outbreaks, particularly against Enterovirus 71 4