Hand, foot and mouth disease (HFMD) is a very common viral infection that predominantly affects children under the age of 5, but it can also strike adults. It is characterized by fevers, skin rash, mouth sores and sometimes gastrointestinal complaints, including diarrhea.
There are two patterns, typical HFMD and atypical HFMD, also known as eczema coxsackium. For typical HFMD, pink flat or slightly raised spots, blisters or erosions cover the palms, soles and inside of the mouth. For atypical HFMD, skin rashes may be more extensive, involving the arms, legs, diaper area, skin around the mouth and any areas of previous eczema or rashes.
HFMD is very contagious. Outbreaks in day care centers and schools are common. It is spread through contact with droplets when an infected person talks, coughs or sneezes, touching skin lesions or feces or coming into contact with objects and surfaces that have been contaminated. The virus can be shed in the feces for up to 6 weeks after the start of the infection. Washing and sanitizing the hands is important in preventing spread of the disease, especially after changing diapers or going to the bathroom. While uncommon, spread at public swimming pools can occur if the pool water is not properly treated.
In the United States, coxsackie A6 virus is the most common cause of typical HFMD, while coxsackie A16 virus is the most common cause of atypical HFMD/eczema coxsackium. Many adults may not be immune to coxsackie A16, so young children can transmit it to their parents/caregivers in certain instances.
Symptoms of HFMD include:
Fevers and feeling unwell occur prior to or with onset of the skin rash and mouth sores. Mouth sores can worsen appetite due to discomfort. Diarrhea can occur before, during or after the skin rash appears. The skin and oral lesions in HFMD do not scar, though discoloration from the spots takes weeks to a few months to completely resolve. While alarming, nail shedding/loss of nails can occur weeks to a few months after HFMD. It is not painful or dangerous, and the nails regrow on their own.
There is no specific treatment for the viruses that cause HFMD. For fevers and discomfort, over-the-counter medicines like acetaminophen and ibuprofen can be used. (Note: aspirin should not be used in children.) It is important to drink plenty of fluids to prevent dehydration. If mouth sores are particularly bothersome, ask your doctor for treatments that may ease discomfort like lidocaine gel or magic mouthwash. For skin rashes, if bothersome or widespread, health care providers like those at Boston Children's Hospital may recommend moisturizers or a topical steroid (for eczema coxsackium).
Living with HFMD can be uncomfortable, but symptoms do get better within seven to 10 days for most people. Focus on staying hydrated, resting, being as comfortable as possible and preventing transmission through good hand hygiene. If your child has signs of HFMD and is younger than 6 months, has a weakened immune system, has severe disease or fevers for more than three days or is not drinking, contact your health care provider immediately.