Hand, foot, and mouth disease

Published on 05/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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Hand, foot, and
mouth disease

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Oral vesicles of hand, foot, and mouth. There are painful, white, aphthae-like erosions on the tongue, lips, and hard palate. Eating can be painful.

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Palmar and plantar vesicles appear cloudy with a small red halo. These lesions may be tender or asymptomatic. They may be sparse or numerous.

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Typical vesicles of hand, foot, and mouth disease on the heel. Pain may impede walking, although generally this is a mild illness.

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Multiple discrete cloudy vesicles with inflammatory halos on the palm are characteristic of hand, foot, and mouth disease.

DESCRIPTION

Highly contagious viral infection that causes aphthae-like oral erosions and a vesicular eruption on hands and feet. The classic benign, self-limited form of this disease is associated with coxsackievirus A16. Enterovirus 71 is a picornavirus genetically related to coxsackie A16. It can cause oral ulcers and similar skin exanthem, but epidemic outbreaks have associated potentially serious neurologic and cardiopulmonary complications, particularly in children under 4 years.

HISTORY

• Incubation period 4–6 days. Epidemics in summer and autumn but may appear any time. • Usually presents with acute stomatitis and mild fever. Mild sore throat and malaise or abdominal pain for 1–2 days may occur. • About 20% of patients develop submandibular lymphadenopathy, cervical lymphadenopathy, or both. • Children younger than 5 years most commonly affected; rate of infection among close household contacts is high. • Enterovirus 71 outbreaks commonly include fever, oral ulcers and/or extremity rash, vomiting, cough.

PHYSICAL FINDINGS

• Number of oral aphthae-like erosions (3–6 mm) varies from few to 10 or more. They are irregularly distributed anywhere in oral cavity. More painful in younger children. Each erosion lasts 3–5 days. • Cutaneous lesions in coxsackie-induced hand, foot, and mouth disease occur in two-thirds of patients and appear less than 24 h after oral lesions. • Skin lesions begin as 3- to 7-mm red macules that rapidly become pale, white, oval vesicles with red areolae. Vesicles have unique rhomboidal shape of ‘square blisters’. May be a few or dozens. • Vesicles occur on palms, soles, dorsal aspects of fingers and toes, and occasionally on face, buttocks, legs. • Heal in approximately 7 days, usually without crusting or scarring. • Diagnosis usually made clinically; laboratory tests unnecessary for the benign presentation of the disease.

TREATMENT

• Hand, foot, and mouth disease caused by coxsackie A16 usually mild and self-limited. Resolves without treatment in about 10 days. • Oral ulcerations painful in infants and interfere with feeding. • Recent emergence of epidemics of hand, foot, and mouth disease caused by enterovirus 71 are associated with varied neurologic syndromes, including aseptic meningitis, Guillain–Barré syndrome, polio-like paralysis, acute transverse myelitis, acute cerebellar ataxia, intracranial hypertension, febrile convulsions. Prodrome is 1–7 days before neurologic disease and has fever, coryza, malaise, headache, diarrhea. Two-thirds of those affected may have a rash, often truncal; herpangina-type lesions may occur in mouth.