Hand-foot-and-mouth disease

• ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, respiratory system, mouth, skin, mucous membranes
• CAUSES: Viral infection
• SYMPTOMS: Low-grade fever, sore mouth, oral lesions that rupture into painful ulcers, skin lesions on hands and feet
• DURATION: Seven to ten days
• TREATMENTS: None (self-resolving); topical anesthetic agents for mouth lesions

DEFINITION: An enteroviral disease that usually affects children, causing vesicular eruptions on the hands, feet, oral mucosa, and tongue

Causes and Symptoms

Hand-foot-and-mouth disease is usually caused by coxsackievirus A16, but it may also be associated with a number of other coxsackieviruses and enterovirus 71. Outbreaks of the disease are most common in the summer and early fall. Infants and young children aged five to seven are most commonly infected because they have not had previous exposure to the virus and, therefore, have less immunity than adults. They often become infected through contact with the nasal and oral secretions of infected children, and nursery school outbreaks may occur. Skin lesions and fecal material may also contribute to the spread of the virus. The incubation period typically ranges from three to seven days after exposure.

The illness commences with a low-grade fever (101 to 103 degrees Fahrenheit; 38 to 39 degrees Celsius) and a sore mouth. Oral lesions begin as small, red macules and evolve rapidly into fragile vesicles that rupture, leaving painful ulcers. Any part of the mouth may be involved, but the hard palate, buccal mucosa, and tongue are mainly affected, with an average of five to ten lesions. Similar lesions develop on the skin over the next one to two days; they usually number twenty to thirty, but there may be as many as one hundred. Discrete macular lesions, about 4 millimeters in diameter, appear on the hands and feet and sometimes the buttocks. These lesions often occur along skin lines and progress to become papules and white or gray flaccid vesicles containing infectious virus. The lesions may be painful or tender. The fever typically occurs during the first one to two days of the illness and resolves within seven to ten days. Rarely, the viral infection is complicated by meningoencephalitis, carditis, or pneumonia.

Treatment and Therapy

There is no specific treatment for hand-foot-and-mouth disease. The infection usually resolves without complications in about one week. Topical anesthetic agents, such as viscous lidocaine, may be used to soothe the discomfort of the mouth lesions. Popsicles and cool sherbets may be given to young children to help soothe a sore mouth. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) given at an appropriate dosage for the body weight of the child may also help to relieve the pain of this condition. Some pediatricians recommend a blend of Benadryl (diphenhydramine) and liquid antacid to relieve the stinging sensation of the mouth lesions.

Perspective and Prospects

The first described outbreak of this disease occurred in Toronto, Canada, in 1957. British authors first coined the term “hand-foot-and-mouth disease” when they reported an outbreak in Birmingham, England, in 1959. While there are no cure-all medications available for treating enteroviral infections, several antiviral agents, including pleconaril, have been studied and may be useful for complicated forms of this disease, such as meningoencephalitis. However, these treatments remain experimental.

A monovalent vaccination, or a vaccine against one virus, was developed and implemented in China beginning in the 2010s. This vaccine protects against enterovirus A71 (EV-A71), but by the mid-2020s, no such vaccine was introduced in the United States. However, bivalent vaccines protecting against enterovirus and coxsackievirus, which cause hand-foot-and-mouth disease, continued to be studied.

Bibliography

"About Hand, Foot, and Mouth Disease ." Centers for Disease Control and Prevention, 7 May 2024, www.cdc.gov/hand-foot-mouth/index.html. Accessed 4 Sept. 2025.

Barnhill, Raymond, et al. Textbook of Dermatopathology. 4th ed., McGraw-Hill, 2019.

Blaser, Martin J., et al. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 10th ed., Churchill Livingstone/Elsevier, 2025.

Cohen, Bernard A. Pediatric Dermatology. 5th ed., Saunders Elsevier, 2021.

Collier, Leslie, et al. Human Virology. 5th ed., Oxford UP, 2016.

"Hand-Foot-Mouth Disease." Medline Plus, 8 July 2023, medlineplus.gov/ency/article/000965.htm. Accessed 4 Sept. 2025.

Liu, Z., et al. "The Burden of Hand, Food, and Mouth Disease among Children under Different Vaccination Scenarios in China: A Dynamic Modeling Study." Infectious Diseases, vol. 21, no. 650, 5 July 2021, doi:10.1186/s12879-021-06157-w. Accessed 4 Sept. 2025.

Saavedra, Arturo P., et al. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 9th ed., McGraw-Hill, 2023.

Yi, Eun-Je, et al. “Potential of a Bivalent Vaccine for Broad Protection against Enterovirus 71 and Coxsackie Virus 16 Infections Causing Hand, Foot, and Mouth Disease.” Vaccine, vol. 41, no. 41, 2023, pp. 6055–63, doi:10.1016/j.vaccine.2023.08.029. Accessed 4 Sept. 2025.

Zhu, Peiyu, et al. Current Status of Hand-Foot-Mouth Disease." Journal of Biomedical Science, vol. 30, no. 15, 24 Feb. 2023, doi:10.1186/s12929-023-00908-4. Accessed 4 Sept. 2025.