By Gary M. White, MD

Hand, Foot and Mouth Disease
Silver, grey or white vesicles occur on the hands, feet and mouth.

Hand, foot and mouth disease (HFMD) is an infection usually caused by the virus Coxsackie A16. Young children are typically affected and epidemics are common. A low-grade fever, malaise, and lymphadenopathy may accompany the vesicles.


The child usually develops mild, nonspecific symptoms for a day or two, e.g., mild fever, malaise. Then, small silvery vesicles develop on the palms, soles, and in the mouth. The buttocks is a common site as well. Constipation is common. Multiple children in one family may be affected. Occasionally, a parent will develop symptoms.

A more severe form with fevers, joint pains, and widespread painful eruptions has been reported and is associated with coxsackie virus A6 [JAMA Derm Dec 2013; 149;1419]. Very rarely, meningitis, encephalitis, interstitial pneumonitis, myocarditis, or acute flaccid paralysis may develop and some patients have died [AD 1999;135;102].

Nail changes associated with HFMD usually occurs within 1 to 2 months after onset, mainly presents as onychomadesis, and is a self-limited process [PD 2016;33;424].


Treatment is usually not needed as the disease spontaneously remits after a week or so. Skin lesions, stool, and respiratory secretions are contagious so good hand washing should be done. Viral particles were found in stool for up to 6 weeks in one study [World J Pediatr. 2015 Nov;11(4):380-5]. If blisters become big enough, they can be popped. Patients with the more severe form may require hospitalization.


The experimental Sinovac EV71 vaccine provides a sustained high protection against EV71-associated HFMDs for up to 2 years [Expert Rev Vaccines. 2015 Oct 13:1-9].

There was one report of the antiviral oseltamivir given as treatment in the setting of HFMD [Indian Pediatr. 2015 Aug 8;52(8):716].

Additional Pictures

Hand, Foot and Mouth Disease Hand, Foot and Mouth Disease Hand, Foot and Mouth Disease Hand, Foot and Mouth Disease Hand, Foot and Mouth Disease Hand, Foot and Mouth Disease

More lesions in the same patient.
Hand, Foot and Mouth Disease Hand, Foot and Mouth Disease


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