Duration of Hand Lesions in Hand, Foot, and Mouth Disease
Hand lesions in HFMD typically resolve within 7-10 days from onset. 1, 2
Timeline of Hand Lesion Evolution
The hand lesions follow a predictable progression:
- Initial presentation: Small pink macules appear on the palms, typically 1-2 days after fever onset 3, 4
- Vesicular stage: These macules evolve into characteristic vesicular lesions within 24-48 hours 3, 4
- Rupture and desquamation: The vesicles subsequently rupture and cause desquamation, particularly on the palms 4
- Complete resolution: The entire process from onset to complete healing typically takes 7-10 days 1, 5
Important Clinical Variations
Coxsackievirus A6 Strain
Patients infected with CVA6 may experience:
- Longer duration of disease compared to typical HFMD strains 2
- More severe skin manifestations with wider distribution beyond classic sites 2
- Higher fever accompanying the lesions 2
Late Manifestations
- Beau's lines (deep transverse nail grooves) may appear approximately 1-2 months after fever onset, representing a delayed sequela rather than active disease 6
- Periungual desquamation typically begins 2-3 weeks after onset of fever 6, 3
Return to Activities
Children can return to daycare once fever has resolved and mouth sores have healed, even if hand lesions are still present. 3 Exclusion based solely on healing skin lesions is not necessary, as by the time HFMD is diagnosed, the child has likely been shedding virus for weeks 3.
When to Reassess
- Monitor for secondary bacterial infection if lesions show increased redness, warmth, purulent drainage, or worsening pain 3
- Re-evaluate after 2 weeks if lesions are not improving with standard supportive care 3
- Consider alternative diagnoses after 4 weeks if evidence of infection has not resolved 3
Common Pitfalls to Avoid
- Do not confuse HFMD with Kawasaki disease: HFMD has discrete vesicles, not diffuse erythema of palms 4
- Do not delay treatment if Rocky Mountain spotted fever is suspected (fever with tick exposure and palmar rash), as this requires immediate doxycycline 7, 4
- Avoid aggressive wound care for hand lesions; washing daily with careful drying is sufficient 3