Duration of Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease typically resolves within 7 to 10 days from symptom onset, with lesions healing spontaneously during this timeframe. 1
Typical Disease Timeline
Initial Phase (Days 1-2)
- Fever appears first, usually low-grade but can exceed 102.2°F (39°C), accompanied by malaise, sore throat, and irritability 2
- Constitutional symptoms dominate before the characteristic rash develops 1
Active Phase (Days 2-7)
- Oral ulcerations and the characteristic maculopapular or papulovesicular rash on hands and feet emerge after the initial fever 1
- Lesions evolve from small pink macules to vesicular lesions over several days 2
- Symptoms typically last less than 1 week in most cases 3
Resolution Phase (Days 7-10)
- Lesions usually resolve completely within 7 to 10 days without intervention 1
- Symptoms resolve spontaneously in the vast majority of uncomplicated cases 4
Important Clinical Variations
Coxsackievirus A6 Strain
- This emerging strain causes longer duration of disease compared to typical HFMD 5
- Patients often experience higher fever and more prolonged symptoms than with traditional CVA16 or EV71 strains 5
- More severe skin manifestations with wider distribution may extend the symptomatic period 5
Return to Activities
- Children can return to daycare once fever resolves and mouth sores heal, even if skin rash persists 6
- Exclusion based solely on healing skin lesions is unnecessary since viral shedding occurs for weeks regardless 6
Red Flags Requiring Extended Monitoring
Watch for indicators of severe disease that may prolong the clinical course beyond typical 7-10 days 7:
- Persistent hyperthermia beyond expected timeframe 7
- Nervous system involvement (altered mental status, lethargy) 7
- Worsening respiratory rate or rhythm 7
- Circulatory dysfunction 7
When to Reassess
- If lesions have not improved after 2 weeks, reassess and consider alternative diagnoses 6
- If evidence of infection persists after 4 weeks, re-evaluate for other conditions 6
Common Pitfalls
- Do not expect immediate resolution—the full 7-10 day course is normal and expected 1
- Skin lesions may persist after other symptoms resolve; this does not indicate treatment failure or need for isolation 6
- CVA6-associated HFMD may last longer than the typical timeframe, which is not necessarily a complication 5