Hand-foot-and-mouth disease

  • Overview

    Hand-foot-and-mouth disease: Overview

    Doctor-examining-child.jpg
    Child with hand-foot-and-mouth disease: The disease often causes painful mouth sores that last for 7 to 10 days.
    What exactly is hand-foot-and-mouth disease?

    Hand-foot-and-mouth disease (HFMD) is a contagious disease caused by a virus. While one of several viruses can cause it, the signs are usually the same:

    • An itchy rash on the hands, feet, or both
    • Mouth sores

    You can catch HFMD from having close contact with a person who has it. You can also catch it when you touch something, such as a toy or doorknob, contaminated with a virus that causes this disease.

    While many people worry that they can get HFMD from a pet or other animal, you cannot. Animals cannot get HFMD.

    Some animals get a different disease called foot-and-mouth disease (aka hoof-and-mouth disease). Foot-and-mouth disease only develops in animals that have hooves, such as cows, sheep, and pigs. People cannot get it.

    In the United States, HFMD tends to be mild. It usually:

    • Develops in children younger than 5 years old
    • Clears on its own in 7 to 10 days without leaving a trace

    When HFMD clears, the person who had it develops an immunity to the virus that caused the disease. Because several viruses can cause HFMD, some people get HFMD again from a different virus.

    In the United States, most people get HFMD during the spring, summer, or fall. That’s when the viruses that cause it are most likely to spread. In the tropics, HFMD tends to occur year round.

    How long is someone with HFMD contagious?

    People who have HFMD tend to be most contagious during the first week that they have the virus.

    To prevent spreading the virus to others, the Centers for Disease Control and Prevention (CDC) recommends keeping a child with HFMD home until the:

    • Fever stops
    • Sores heal

    The CDC recommends this because children often have close contact with each other, which can spread the virus.

    You can see what HFMD sores look like at:
    Hand-foot-and-mouth disease: Signs and symptoms


    Image
    Getty Images

    References
    Belazarian L, Lorenzo ME, et al. “Exanthematous viral diseases.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1867-9.

    Centers for Disease Control and Prevention (CDC). “Hand-foot-and-mouth disease.” Last updated December 22, 2017. Last accessed May 25, 2018.

    Lott JP, Liu K, et al. “Atypical hand-foot-and-mouth disease associated with coxsackievirus A6 infection.” J Am Acad Dermatol. 2013;69:736-41.

  • Symptoms

    Hand-foot-and-mouth disease: Signs and symptoms

    hand-foot-mouth-signs-symptoms.jpg
    Child with hand-foot-and-mouth disease: Reddish spots often develop on the soles and palms, which quickly turn into bumps or blisters.

    Signs and symptoms in children

    When a child gets hand-foot-and-mouth disease (HFMD), most signs and symptoms clear within 7 to 10 days. Here’s what you may see during that time:

    Days 1–2

    For 1 or 2 days, you may notice that your child feels unwell and has one or more of the following:

    • A mild fever
    • A sore throat
    • Stomach pain
    • Less of an appetite

    Days 3–7 (or longer)

    After 1 or 2 days, the above symptoms tend to clear and you may see:

    • Mouth sores
    • An itchy rash, usually on the feet, hands, or both
    • Swollen lymph nodes in the neck

    Mouth sores: Most children have a few painful mouth sores, which usually develop on the tongue. Sores can also appear elsewhere in the mouth, including the roof of the mouth. Mouth sores tend to begin as bright pink spots or tiny bumps, which turn into blisters. The blisters can be painful.

    Itchy rash: While an itchy rash tends to develop on the hands or feet, it can appear elsewhere on the body, such as the knees or elbows.

    While a child can develop all of these signs and symptoms of HFMD, most children only have a few.

    Painful mouth sores may cause your child to stop drinking, which can lead to dehydration. If you notice that your child won’t drink, contact your child’s doctor.

    hand-foot-mouth-signs-symptoms-child-refuse-drink.jpg

    Signs and symptoms in adults

    Most adults who gets HFMD never develop signs or symptoms. When they do, the signs and symptoms are the same as those that children get.

    Signs and symptoms clear quickly

    While most signs and symptoms of HFMD clear within 7 to 10 days, children younger than 2 years of age may be sick longer. It can take more time for their bodies to get rid of the virus.

    You can find out how HFMD spreads from person to person and how you’re most likely to get the virus at:
    Hand-foot-and-mouth disease: Who gets and causes


    Images
    Image 1:  J Am Acad Dermatol. 2013;69:736-41
    Image 2: Getty images

    References
    Belazarian L, Lorenzo ME, et al. “Exanthematous viral diseases.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1867-9.

    Centers for Disease Control and Prevention (CDC). “Hand-foot-and-mouth disease.” Last updated December 22, 2017. Last accessed May 25, 2018.

    Lott JP, Liu K, et al. “Atypical hand-foot-and-mouth disease associated with coxsackievirus A6 infection.” J Am Acad Dermatol. 2013;69:736-41.

  • Causes

    Hand-foot-and-mouth disease: Who gets and causes

    hand-foot-mouth-who-gets-babies-around-world.jpg
    Babies have a higher risk of getting hand-foot-and-mouth disease: Around the world, hand-foot-and-mouth disease is considered a common childhood disease.

    Who gets hand-foot-and-mouth disease?

    Infants and children younger than 5 years of age are most likely to get hand-foot-and-mouth disease (HFMD)1. The disease is common in this age group because it takes time for the human body to develop immunity to the viruses that cause HFMD.

    Older children and adults can get HFMD, but this is less common.

    Outbreaks (i.e., when many people in one location suddenly develop the disease) of HMFD occur around the world. These may be more common in Asia. In China, there were nearly 2 million cases of HFMD in 2015.  The largest outbreak occurred in Taiwan in 1998, afflicting more than 120,000 people.2

    Outbreaks are rare in the United States.

    What causes HFMD?

    HFMD is a contagious disease. It spreads when someone who has HFMD passes a virus that causes the disease to another person. There are several different viruses that can cause HFMD.

    To catch a virus that causes HFMD, you usually need close contact with the infected person. You can get the virus when you:

    • Swallow (or breath in) droplets of infected salvia, mucus, or feces
    • Touch fluid from a blister caused by HFMD
    • Handle a contaminated object, such as a toy

    It’s also possible to get HFMD when you swallow water from a swimming pool that has particles of infected feces. This is less common and happens when a pool is maintained poorly.

    You cannot catch HFMD from a pet or any other animal.

    If you catch HFMD, a board-certified dermatologist can tell you if that’s what you have.

    To find out how this disease is diagnosed and treated, go to:
    Hand-foot-and-mouth disease: Diagnosis, treatment, and outcome


    Image
    Getty Images

    References
    Belazarian L, Lorenzo ME, et al. “Exanthematous viral diseases.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1867-9.

    1,2Centers for Disease Control and Prevention (CDC). “Hand-foot-and-mouth disease: Outbreaks.” Last updated December 22, 2017. Last accessed May 24, 2018.

  • Treatment

    Hand-foot-and-mouth disease: Diagnosis, treatment, and outcome

    Hand-foot-and-mouth disease (HFMD) tends to go away on its own without treatment and without leaving a trace.

    How do dermatologists diagnose hand-foot-and-mouth disease?

    Most doctors can diagnose HFMD by:

    • Looking at the rash and mouth sores
    • Considering the patient’s age
    • Asking about symptoms

    Sometimes, your doctor will swab your mouth or get a stool sample. In a laboratory, these can be checked for viruses that cause HFMD.

    How do dermatologists treat hand-foot-and-mouth disease?

    This disease goes away on its own without treatment. In most cases, HFMD is gone in 7 to 10 days.

    If you or your child has pain or other symptoms, a dermatologist can provide treatment to relieve symptoms.

    At home, the following can help ease symptoms of HFMD:

    • Avoid eating any food that is spicy or acidic. These foods can make the mouth sores more painful.

    • Drink cold liquids. Drinking a warm or hot beverage can be painful when someone has mouth sores. Because it’s important to stay hydrated, dermatologists recommend drinking cold liquids.

    • Reduce the fever. Avoid giving a child or teenager aspirin because aspirin can cause Reyes syndrome, which may lead to brain and liver damage. Reyes syndrome usually develops after a child (or teen) takes aspirin while fighting off a virus. HFMD is caused by viruses.

      While aspirin can cause problems, acetaminophen is generally safe and effective for reducing fever in children and teens. Just be sure to follow the dosing, which is based on a child’s weight.

      Adults can take aspirin.

    • Alleviate pain from mouth sores. Cold beverages, such as water, can help. Adults can also use a numbing mouthwash or spray to reduce the pain.

    What is the outcome for someone who has hand-foot-and-mouth disease?

    For most people, the disease goes away in 7 to 10 days without leaving a trace.

    In the United States, it’s rare for a virus that causes HFMD to lead to a more serious disease. A few people have developed viral meningitis, which causes inflammation in the brain and spinal cord. Symptoms of viral meningitis include an excruciatingly painful headache and neck stiffness.

    There have also been a few reports of people getting encephalitis (swelling in the brain). This can cause an excruciatingly painful headache and confusion.

    Other problems have been reported. In a few cases, people lose one or more fingernails or toenails. Their nails usually regrow normally.

    While HFMD tends to go away on its own in 7 to 10 days, it may be possible to prevent it. Find out what you can do at:
    Hand-foot-and-mouth disease: Tips for preventing


    References
    Belazarian L, Lorenzo ME, et al. “Exanthematous viral diseases.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1867-9.

    Centers for Disease Control and Prevention (CDC). “Hand-foot-and-mouth disease: Outbreaks.” Last updated December 22, 2017. Last accessed May 24, 2018.

    Chiu HH, Lan CCE, et al. “Onychomadesis following hand-foot-and-mouth disease.” Cutis. 2016 May;97(5):E20-1.

    Nervi SJ, Schwartz RA, et al. “Hand-foot-and-mouth disease (HFMD).” Medscape. Last updated Jun 16, 2017. Last accessed May 29, 2018.

    Renda S and Sanches M. “Hand-foot-and-mouth disease in adults.” Clin Adv. August 11, 2017. Last accessed May 24, 2018.

  • Tips for preventing

    Hand-foot-and-mouth disease: Tips for preventing

    hand-foot-mouth-tips-hand-washing.jpg
    Hand washing can help prevent you from getting hand-foot-and-mouth disease: Frequently washing your hands can prevent you from catching so many diseases that the Centers for Disease Control and Prevention (CDC) calls hand washing a "do-it-yourself vaccine.”

    While there is currently no vaccine for hand-foot-and-mouth disease (HFMD), you can lower your risk of catching it.

    Most people become infected when someone in their home has the disease. The Centers for Disease Control and Prevention (CDC) recommends the following when a household member has HFMD or you travel to an area of the world where outbreaks of HFMD are common, such as parts of Asia:

    1. Wash your hands with soap and water often. Hand washing is especially important:

    • After using the toilet
    • After changing diapers or potty training
    • Before eating
    • Before preparing food

    You’ll find other times the CDC recommends hand washing and how to effectively wash your hands at:

    When and how to wash your hands

    Because soap and water may not always be available, it can help to carry a travel-size hand sanitizer with you.

    1. Keep your hands away from your eyes, nose, and mouth. If a virus that causes HFMD is on a doorknob, toy, or other surface, you can get HFMD by touching the surface and later your face. The virus can get inside your body through your mouth, eyes, or nose.

    2. Avoid close contact with anyone who has HFMD. This disease often spreads when the infected person coughs or sneezes. Until you’re sure the person can no longer spread the virus to others, try to avoid getting too close, if possible.

      Most people are no longer contagious after 7 to 10 days, but it can take longer.

      Because the virus can spread with close contact, it also helps to stop kissing, hugging, and sharing food with the infected person.

    3. Disinfect counters, doorknobs, and other surfaces that people frequently touch. The virus that causes HFMD can spread from one person to another when you touch an infected surface. Disinfecting counters, doorknobs, toys, and other surfaces can help prevent the disease from spreading.


    Image
    Getty Images

    Reference
    Centers for Disease Control and Prevention, “Hand-foot-and-mouth-disease.” Last updated December 22, 2017. Last accessed May 25, 2018.