Hand-Foot-Mouth Disease- Dermatology, General Medicine/ Check Up, Pediatrics

Hand, foot, and mouth (HMF) disease is a mild, contagious viral infection that is frequent in young children. The condition is caused by a group of enteroviruses, most commonly coxsackievirus.

The infection causes painful, red blisters in the throat, mouth, feet, hands, and diaper area. Although commonly seen in children, HFM disease can also affect adults. In addition to the blisters, children frequently experience a brief fever and may get dehydrated due to the discomfort of swallowing liquids.

HFM is contagious and quickly spreads through contact with unwashed hands, mucus from the nose, saliva, feces, or fluid from the blisters. There is no specific treatment for HFM disease. It usually gets better on its own in seven to ten days.

The contagious viral disease known as foot-and-mouth disease, also called hoof-and-mouth disease, is unrelated to hand, foot, and mouth disease. Pets or other animals cannot contract HFM disease from you, and you cannot transmit it to them.

Symptoms Of Hand Foot And Mouth Disease

Symptoms appear three to six days after contracting the infection. This time frame is called the incubation period. Symptoms of HFM disease are

• Fever
• Sore throat
• Reduced appetite
• Irritability
• Drooling
• Red, painful sores in the mouth
• Malaise
• Red rash on the soles of the feet and hands

The earliest signs of HFMD are typically fever and sore throat. The recognizable rashes and blisters appear later, typically 1 or 2 days after the fever starts.

Usually, the rash appears as flat, red patches or spots. However, darker skin tones can make the spots challenging to discern, so it's easier to examine the bottoms of the palms of the hands and the feet, where the condition might be more obvious.

Although lesions can develop on any part of your hands or feet, this is one of the few instances where you notice a rash on your palms and soles, making it simple to spot. Unfortunately, the majority of kids with HFMD also experience painful mouth sores.

Sores on the back of the mouth and throat could be signs of herpangina, a virus-related illness. Symptoms of herpangina also include abrupt, high fever and, in some cases, seizures. Rarely, sores may appear on the hands, feet, or other body parts.

Causes

The Picornaviridae family of viruses is responsible for the illness. The most frequent cause of HFM disease is coxsackievirus A16, with enterovirus 71 (EV-71) coming in second. Other additional enterovirus and coxsackievirus strains can be the causative agent.

Most people contract hand, foot, and mouth disease and the coxsackievirus infection through their mouths. Person-to-person contact with an infected person is the primary method of disease transmission.

The viruses lurk in the fluids in an infected person's body, including:

• Throat or nasal discharge
• Saliva
• Fluid from blisters or scabs
• Stool
• Respiratory droplets after a cough or sneeze

The disease can spread by sneezing or coughing, kissing, embracing, sharing cups, sharing utensils, or feces contacts, such as when changing a diaper and touching objects with the virus.

Risk Factors

The primary risk factor for HFM disease is age. Most of the disease's victims are children under 5 to 7 years old. Attending daycare or school puts them at greater risk because infections can spread quickly in these settings. Diaper changes, toilet training and children often put their hands into their mouths are other important factors responsible for fast transmission in child care.

Although it mainly affects small children, anyone can contract HFM disease.

It is believed that adults and older children are immune to HFM disease. This is because they frequently produce antibodies after exposure to disease-causing viruses. This is why people older than ten are rarely affected by the illness. However, children and adults can still contract HFM disease, significantly if their immune systems are compromised.

When To See A Doctor?

Call your doctor if your child is still highly irritable, won't calm down, is lethargic, or appears to be worsening. Also, call if you notice other dehydration symptoms, such as a dry or sticky tongue, sunken eyes, less frequent urination, or wet diapers.

You should also see your doctor if:

• After seven to ten days, neither your symptoms nor your child's symptoms improve.
• You or your child feel shaky and hot or have a very high temperature.
• You contract HFM illness while pregnant.

How Is It Diagnosed?

Your child's pediatrician or health care provider will likely decide if your child has HFM disease or other viral infections by evaluating the following:

• Your child's age
• Symptoms in your child
• How the rash or sores on your child's body appeared

A stool sample or throat swab may be taken by the medical professional treating your child. To identify the specific virus that caused the sickness, your child's healthcare professional will send a sample to a lab.

Expect the following questions from your child's doctor:

• When did your child's symptoms begin to appear? 
• How severe are the symptoms in your child?
• Have your child's symptoms been ongoing or only occasionally present?
• Have any illnesses been reported at your child's daycare or school?
• Has your child recently come into contact with any sick people?
• What, if anything, seems to worsen your child's symptoms?
• What, if anything, seems to improve your child's symptoms?

Treatment

The infection will often disappear without treatment in 7 to 10 days. However, until the disease has run its course, your doctor can suggest certain medications and measures to help with symptom relief. These may include:

• Over-the-counter or prescription topical ointments to relieve blisters and rashes.
• Lozenges or medicated syrups to relieve sore throat pain.
• Headache relief with painkillers like acetaminophen or ibuprofen. Never give aspirin to kids or teenagers since it can lead to Reye syndrome, an uncommon but deadly condition.
• Children who have problems swallowing (and those who don't!) will enjoy cold treats like ice cream, popsicles, and smoothies since they numb the area. Hot beverages, acidic foods (tomato sauce, citrus juice, etc.), and sodas should all be avoided as they can exacerbate the pain.
• Blisters on the hands or feet of children should be kept clean and unprotected. First, use lukewarm soap and water to clean the skin, then pat it dry. If a blister pops, apply a small amount of antibiotic ointment to help prevent infection, then wrap it up.
• To stay hydrated, make sure your youngster consumes enough water.

Vaccine For HMF Disease

The EV-A71 vaccination has been used in China since 2016. According to a 2022 paper published in The Lancet, the introduction of the EV-A71 vaccine has effectively reduced HFM disease's severity and mortality rates. However, there is no vaccine available in America or the European Union.

Complications

Potential complications of HFM disease include:

• Loss of a fingernail or toenail
• Dehydration
• Infectious meningitis (viral)
• Myocarditis
• Encephalitis
• Paralysis

HFM Disease In Pregnancy

It is best to avoid close contact with anyone with hand, foot, and mouth disease, even though there is typically no risk to the pregnancy or the unborn child.

This is due to the following:

• A high fever during the first three months of pregnancy can result in miscarriage, though this is relatively uncommon.
• A mild form of hand, foot, and mouth illness may be present in your newborn if you contract it just before giving birth.

Prevention

HFM disease is the most contagious in the first seven days of the illness. But the virus can stay in the body for days or weeks and spread through their spit, respiratory droplet, fluid in the blisters, or feces. As a result, the disease can quickly be passed on, even a few days before the onset of symptoms.

Take these steps to prevent or minimize the spread of infection:

• Wash your hands frequently with soap and water and teach your kids to do the same.
• Throw away soiled tissues as soon as you can.
• When you sneeze or cough, use tissues to trap the germs.
• Use a hot wash cycle to clean dirty bedding and clothing.
• Don't share household items like cups or cutlery, or towels.
• When ill, keep your child away from daycare or school.  Kids can return to school or the daycare center after they feel better. There's no need to hold off until every blister has recovered.

The Bottom Line

Hand, foot, and mouth disease is a common childhood infection that causes sores inside or around the mouth and blisters or rashes on the hands, legs, feet, or buttocks. It can be painful, but it isn't severe and typically resolves independently.

The best way to prevent HFM disease is to maintain good hygiene. Handwashing frequently can significantly lower your and your child's risk of contracting this virus.

Keep your child at home, away from daycares or school, if they have symptoms like a fever or sore throat. Once the blisters and rashes appear, avoiding contact with other people is better. You can prevent the disease from spreading to others by doing this.

To learn more about HFM Disease, please check our blog on HAND, FOOT AND MOUTH DISEASE.

Sources

• Hong, Jie et al. “Changing epidemiology of hand, foot, and mouth disease in China, 2013-2019: a population-based study.” The Lancet regional health. Western Pacific vol. 20 100370. 2 Jan. 2022, doi:10.1016/j.lanwpc.2021.100370
• Guerra AM, Orille E, Waseem M. Hand Foot And Mouth Disease. [Updated 2022 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431082/
• “Hand-foot-and-mouth Disease.” Mayo Clinic, 16 Aug. 2022, www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035
• CDC. “Symptoms and Diagnosis of Hand, Foot and Mouth Disease.” Centers for Disease Control and Prevention, 10 Aug. 2022, www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html.
• CDC. “Symptoms and Diagnosis of Hand, Foot and Mouth Disease.” Centers for Disease Control and Prevention, 10 Aug. 2022, www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html.