Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD, also called enteroviral vesicular stomatitis is a common acute viral infection, primarily affecting young children under the age of 5. It is known to appear in a characteristic distribution, involving mucocutaneous lesions over hands, feet and oral cavity.


HFMD transmission is very rapid, mainly via  direct contact with the blister fluid or droplets spread from the mouth.

Numerous coxsackie virus serotypes have been implicated to cause HFMD, most commonly type A16.  Enterovirus 71 infection has been associated with cardiopulmonary and neurologic complications and even deaths in affected young children.

Clinical Features:

Patients with HFMD often present with fever and malaise, and they may have a mild prodrome prior to the onset of the exanthem.

HFMD exanthem is characterized by:

  •  vesicular eruption on the palms and soles. The dorsal aspect of the hands and feet may be involved as well as the buttocks and perineum. The lesions are typically tender and are usually oval rather than round.
  • Oral lesions are most common on the tongue, buccal mucosa, palate, uvula, and anterior tonsillar pillars. They are usually painful, especially with oral intake.
  • Onychomadesis occasionally occurs months after HFMD as a consequence of temporary nail matrix arrest related to the viral infection.


HFMD rarely causes serious complications. Enterovirus 71 is usually associated with more severe infections and complications, especially among immunosuppressed individuals or neonates. Rare serious reported complications include myocarditis, meningoencephalitis, and pulmonary edema.



HFMD is diagnosed clinically based on exposure history, geographic location, and clinical signs and symptoms.

Confirmation of an enteroviral infection may be accomplished by viral testing from vesicular fluid via reverse transcription polymerase chain reaction (RT-PCR)-based assays to determine  the specific type of enterovirus, however, it is done only for research and public health purposes. 



HFMD is a self-limiting disease  with spontaneous resolution typically within 1–2 weeks. Supportive care is the mainstay of treatment, including hydration, analgesic and blister care.

Pleconaril has been demonstrated in recent research and has shown a promising outcome for serious enteroviral infections. It is a specific antiviral therapy that interferes with enterovirus attachment and uncoating by binding to the protein capsid.


Written by:

Maee Barakeh, medical student.


Bolognia textbook of dermatology