Hand Foot and Mouth Disease
Written by: Melissa Boothe, PA-C
Hand Foot and Mouth Disease (HFM) is a common, yet peculiar viral infection primarily affecting young children. Cases are seen most frequently in the late summer & fall, but can happen anytime of year. HFM is due to an enterovirus infection, most commonly Coxsackievirus. It can be highly contagious!
Classic Findings in HFM:
-Flat red spots (macules) and blister-like lesions on the palms & soles (palmar surface) of the hands & feet, but can also be seen on the tops of the hands & feet (dorsal surface)
-Small, red blisters & ulcerations INSIDE & AROUND the mouth, the palate, and throat.
-Red blisters & ulcerations on the buttocks/panty-line/genitalia, as well as scalp/ears, arms, & legs.
-Blister eruption is often preceded by, or accompanied with fever, fatigue, general malaise.
**Photo source: dermnetnz.org
How does the virus spread you ask? HFM is passed on by direct contact with the blisters (particularly open, oozing blisters), nasal & oral secretions, or fecal contamination. It’s most common in kids under 5.
Other peculiar features: fingernail peeling may occur ~2 months after infection. Fortunately, this isn’t full thickness fingernail peeling.. rather, partial thickness peeling where just fragmented portions of the top layer of nail peels off. Fingernails generally return to their norm, within a few more months.
Treatment: no specific treatment, just supportive care! What does “supportive care” mean anyway?! This means taking basic measures to help you or your little one stay comfortable while getting through this unpleasant viral infection that has to run its course.
1) Stay well hydrated! Popsicles never hurt for kids that complain of sore throat from this virus.
2) Diligent unscented moisturizing creams or petroleum jelly (+/- white 100% cotton gloves) to hydrate the skin/improve the epidermal skin barrier/promote faster healing from the blisters.
3) Do not pop the blisters; let them run their course... typically takes 1-2 weeks.
4) Rx-strength topical steroids, if the blisters are significantly itchy or inflamed!!
5) No “oral Rx” is a true treatment of HFM, although oral analgesics such as Acetaminophen & Ibuprofen are wise if the blisters are painful. There is no vaccine or specific anti-viral for HFM.
*Word to the wise! This isn’t just a childhood virus. Teens, adults, and older adults can get it too! Adults often have more severe cases than kids, and are more negatively impacted by the blistering on their hands & feet… their palms/soles may be slower to heal, as well accompanied by arthritis-like pain.
**Photo source: Dermnetnz.org (left); CDC.gov (right)
**Further warnings! Hand foot and mouth can remain contagious in one’s stool for up to 1 month, even long after all blisters have healed! Likely shorter duration in saliva, but unclear. Thus continue diligent efforts at preventing spread from one person to another for at least a month after blisters 1st arise!
How to best prevent?!?! Good hand-washing skills, as goes with most viral & bacterial infections, especially prior to eating meals, after eating, and after visiting the restroom or changing diapers!
When to come see us?! If you have highly bothersome blisters and need tips with skin relief!! Or… if you’re unsure if you truly have HFM, as several other skin conditions may overlap with the appearance of HFM, including but not limited to: dyshidrotic eczema, pustular psoriasis, erythema multiforme, Covid toes, etc. We can help make the diagnosis, and provide you with rapid symptomatic care!