Silver, grey or white vesicles occur on the hands, feet and mouth.

HAND, FOOT, AND MOUTH DISEASE

Hand, Foot and Mouth Disease (HFMD) is an infection usually caused by the enterovirus A which consists of 25 serotypes including multiple Coxsackie A viruses, multiple enteroviruses, simian enteroviruses and baboon enterovirus A13. Young children are typically affected and epidemics are common. A low-grade fever, malaise, and lymphadenopathy may accompany the vesicles.

• The patient is usually < 5 years of age. The average in one study was 2.4 years.
• Eczema herpeticum lesions are seen in 20% of cases.
• In the US, the predominant cause is Coxsackievirus A16.
• 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 have been found in the stool for up to 6 weeks.
• The transmission is: fecal-­‐oral, vesicle fluid, respiratory secretions.
  
• Rare cases of aseptic meningitis, brainstem encephalitis and acute flaccid paralysis may complicate the clinical course.
• Of note, Herpangina and HFMD are both caused by Human enteroviruses e.g. coxsackie but they may have different serotypes. Both diseases tend to affect young children.

Clinical

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. Eczema herpeticum lesions are seen in 20% of cases.

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 (some call "eczema coxsackium") . Very rarely, meningitis, encephalitis, interstitial pneumonitis, myocarditis, or acute flaccid paralysis may develop and some patients have died.

Nail changes associated with HFMD usually occurs within 1 to 2 months after onset, mainly presents as onychomadesis, and is a self-limited process.

Questions to ask

• When did it start?
• Who else in the family has it?
• How are you feeling? Lack of energy? Joint pain? Swollen glands?
• Any fever?
• Any headache? Constipation?
• Where do you have the spots? Mouth? Hands? Feet? Buttocks?
• Any trouble eating (because of mouth sores)?

Treatment

• Rest
• Plenty of Fluids.
• Bland diet if mouth lesions. Can do salt water swish and spit (see below).
• Tylenol for fever or just not feeling well.
• Can pop any blisters if big.
• Avoid others as much as possible.
• Mask if out.
• Good hand washing.

Treatment is usually not needed as the disease spontaneously remits after a week or so. Rest and plenty of fluids is recommended. If mouth sores are a problem, and the patient can rinse without swallowing, swish and spitting with warm salt water may be soothing. It may be done several times a day. (Recipe: mix 1/2 teaspoon of salt into 8 ounces (1 cup) of warm water, stir until dissolved, and then gargle for 15-30 seconds, spitting it out afterward.). A bland diet is also recommended.

Skin lesions, stool, and respiratory secretions are contagious so good hand washing should be done for a month. Viral particles were found in stool for up to 6 weeks in one study. If blisters become big enough, they can be popped. Patients with the more severe form may require hospitalization.

Since respiratory secretions contain the virus, older patients should wear a mask during the acute phase to prevent transmission. It is standard to allow children to return to day care or school once they feel well enough, have been fever-free for 24 hours without using fever-reducing medications, and the blisters are no longer open and draining.

Additional Pictures

A lesion on the tongue.

RegionalDerm

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