Hand, foot, and mouth disease

Not to be confused with Foot-and-mouth disease or Hand-foot syndrome.
Hand, foot and mouth disease
Typical lesions around the mouth of an 11-month-old boy
Classification and external resources
Specialty Infectious disease
ICD-10 B08.4
ICD-9-CM 074.3
DiseasesDB 5622
MedlinePlus 000965
eMedicine derm/175
Patient UK Hand, foot, and mouth disease
MeSH D006232

Hand, foot and mouth disease (HFMD) is a common infection caused by a group of viruses.[1] It typically begins with a fever and feeling generally unwell.[1] This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet, and mouth, and occasionally buttocks and groin.[2][3][4] Signs and symptoms normally appear 3–6 days after exposure to the virus.[5] The rash generally goes away on its own in about a week.[6] Fingernail and toenail loss may occur a few weeks later and these then regrow.[7]

The viruses that cause HFMD are spread through close personal contact, through the air from coughing, and the feces of an infected person. Contaminated objects can also spread the disease.[8] Coxsackievirus A16 is the most common cause and Enterovirus 71 is the second-most common cause.[9] Other strains of coxsackievirus and enterovirus can also be responsible.[9][10] Some people may carry and pass on the virus despite having no symptoms of disease.[1] Other animals are not involved.[8] Diagnosis can often be made based on symptoms. Occasionally throat or stool sample may be tested for the virus.[11]

Handwashing may prevent spread and those infected should not go to work, daycare, or school.[8] No antiviral medication or vaccine is available, but development efforts are underway.[12] Most cases require no specific treatment.[6] Simple pain medication such as ibuprofen or numbing mouth gel may be used. Occasionally intravenous fluids are given to children who are unable to drink enough.[13] Rarely viral meningitis or encephalitis may complicate the disease.[7]

HFMD occurs in all areas of the world.[14] It often occurs in small outbreaks in nursery schools or kindergartens.[4] Large outbreaks have been occurring in Asia since 1997. It usually occurs during the spring, summer, and fall months.[14] Typically it occurs in children less than five years old, but can occasionally occur in adults.[1][4] HFMD should not be confused with foot-and-mouth disease (also known as hoof-and-mouth disease) which mostly affects livestock.[15]

Signs and symptoms

Rash on palms of the hands.
Rash on hand and feet of a 36-year-old man
Rash on the soles of a child's feet

Common constitutional signs and symptoms of the HFMD include fever, nausea, vomiting, feeling tired, generalized discomfort, loss of appetite, and irritability in infants and toddlers. Skin lesions frequently develop in the form of a rash of flat discolored spots and bumps which may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips.[16] The rash is rarely itchy for children,[5] but can be extremely itchy for adults. Painful facial ulcers, blisters, or lesions may also develop in or around the nose or mouth.[4][17][18] HFMD usually resolves on its own after 7–10 days.[17]


The viruses that cause the disease are of the Picornaviridae family. Coxsackievirus A16 is the most common cause of HFMD.[9] Enterovirus 71 (EV-71) is the second-most common cause.[9] Many other strains of coxsackievirus and enterovirus can also be responsible.[9][10]


HFMD is highly contagious and is transmitted by nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by fecal-oral transmission.


A diagnosis usually can be made by the presenting signs and symptoms alone.[17] If the diagnosis is unclear, a throat swab or stool specimen may be taken to identify the virus by culture.[17] The common incubation period (the time between infection and onset of symptoms) ranges from three to six days.[5]


Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting contaminated surfaces, and proper hand hygiene. These measures have been shown to be effective in decreasing the transmission of the viruses responsible for HFMD.[17][19]


A vaccine known as the EV71 vaccine is available to prevent HFMD in China as of December 2015.[20] No vaccine is currently available in the United States.[19]


Medications are usually not needed as hand, foot and mouth disease is a viral disease that typically gets better on its own. Currently, there is no specific curative treatment for hand, foot and mouth disease.[17] Disease management typically focuses on achieving symptomatic relief. Pain from the sores may be eased with the use of analgesic medications. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, but may occasionally run a longer course. Fever reducers and lukewarm baths can help decrease body temperature.

A minority of individuals with hand, foot and mouth disease may require hospital admission due to complications such as inflammation of the brain, inflammation of the meninges, or acute flaccid paralysis.[10] Non-neurologic complications such as inflammation of the heart, fluid in the lungs, or bleeding into the lungs may also occur.[10]


Complications from the viral infections that cause HFMD are rare, but require immediate medical treatment if present. HFMD infections caused by Enterovirus 71 tend to be more severe and are more likely to have neurologic or cardiac complications including death than infections caused by Coxsackievirus A16.[17] Viral or aseptic meningitis can occur with HFMD in rare cases and is characterized by fever, headache, stiff neck, or back pain.[10][17] The condition is usually mild and clears without treatment; however, hospitalization for a short time may be needed. Other serious complications of HFMD include encephalitis (swelling of the brain), or flaccid paralysis in rare circumstances.[16][17]

Fingernail and toenail loss have been reported in children 4–8 weeks after having HFMD.[5] The relationship between HFMD and the reported nail loss is unclear; however, it is temporary and nail growth resumes without treatment.[5][21]


Hand, foot and mouth disease most commonly occurs in children under the age of 10[5][17] and tends to occur in outbreaks during the spring, summer, and fall seasons.[9] HFMD is most commonly caused by infection with Coxsackievirus A16.[9]

Major outbreaks


HFMD cases were first described in New Zealand in 1957.[17]


Novel antiviral agents to prevent and treat infection with the viruses responsible for HFMD are currently under development. Preliminary studies have shown inhibitors of the EV-71 viral capsid to have potent antiviral activity.[12]


  1. 1 2 3 4 "Hand Foot and Mouth Disease". CDC. August 18, 2015. Retrieved 14 May 2016.
  2. Frydenberg, A; Starr, M (August 2003). "Hand, foot and mouth disease.". Australian family physician. 32 (8): 594–5. PMID 12973865.
  3. Ooi, MH; Wong, SC; Lewthwaite, P; Cardosa, MJ; Solomon, T (2010). "Clinical features, diagnosis, and management of enterovirus 71". Lancet Neurology. 9 (11): 1097–1105. doi:10.1016/S1474-4422(10)70209-X. PMID 20965438.
  4. 1 2 3 4 Kaminska, K; Martinetti, G; Lucchini, R; Kaya, G; Mainetti, C (2013). "Coxsackievirus A6 and Hand, Foot, and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review". Case Reports in Dermatology. 5 (2): 203–209. doi:10.1159/000354533. PMID 24019771.
  5. 1 2 3 4 5 6 Hoy, NY; Leung, AK; Metelitsa, AI; Adams, S (2012). "New concepts in median nail dystrophy, onychomycosis, and hand, foot and mouth disease nail pathology". ISRN Dermatology. 2012 (680163): 680163. doi:10.5402/2012/680163. PMID 22462009.
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  8. 1 2 3 "Causes & Transmission". CDC. August 18, 2015. Retrieved 15 May 2016.
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  10. 1 2 3 4 5 Li, Y; Zhu, R; Qian, Y; Deng, J (2012). "The characteristics of blood glucose and WBC counts in peripheral blood of cases of hand foot and mouth disease in China: a systematic review". PLOS ONE. 7 (1): e29003. doi:10.1371/journal.pone.0029003. PMC 3250408Freely accessible. PMID 22235257.
  11. "Diagnosis". CDC. August 18, 2015. Retrieved 15 May 2016.
  12. 1 2 Pourianfar HR, Grollo L (February 2014). "Development of antiviral agents toward enterovirus 71 infection". J Microbiol Immunol Infect. 48: 1–8. doi:10.1016/j.jmii.2013.11.011. PMID 24560700.
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  18. "Hand, Foot and Mouth Disease: Signs & Symptoms". mayoclinic.com. The Mayo Clinic. Retrieved May 5, 2008.
  19. 1 2 "Hand, Foot and Mouth Disease". Prevention and Treatment. Centers for Disease Control and Prevention. 2013. Retrieved 18 October 2013.
  20. Mao, QY; Wang, Y; Bian, L; Xu, M; Liang, Z (May 2016). "EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD).". Expert review of vaccines. 15 (5): 599–606. doi:10.1586/14760584.2016.1138862. PMID 26732723.
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  32. "Coxsackievirus A6 (CVA6)". California Department of Public Health. 2013. Retrieved 16 October 2013.
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