Merck Manual

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Hand-Foot-and-Mouth Disease


Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Last full review/revision Sep 2019| Content last modified Sep 2019
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Hand-foot-and-mouth disease is an enterovirus infection that causes fever and a rash on the hands, feet, and mouth, most often in young children.

  • Hand-foot-and-mouth disease is caused by various enteroviruses and is usually spread by coming into contact with contaminated material or air droplets.

  • Symptoms include fever, painful mouth sores, and a rash.

  • The diagnosis is based on an examination of the mouth sores and rash.

  • Good hand hygiene can help prevent the infection.

  • Treatment includes measures to relieve pain and fever.

This disease can be caused by many different enteroviruses, such as coxsackievirus, and is most common among young children. Hand-foot-and-mouth disease is more common in the spring, summer, and fall but can occur in winter.

People become infected when they come into contact with any of the following:

  • An infected person (for example, by hugging a close personal contact)

  • Droplets spread through the air when an infected person coughs or sneezes

  • Feces, such as changing diapers of an infected person, then touching the eyes, nose, or mouth before washing hands

  • Contaminated objects and surfaces, such as doorknobs, then touching the eyes, mouth, or nose before washing hands

People are most contagious during the first week of illness.


A common symptom of hand-foot-and-mouth disease is fever. This disease affects the skin and mucous membranes, causing painful sores to appear inside the mouth. The rash typically appears on the hands and feet, and occasionally on the arms, upper legs, buttocks, or genitals and less commonly on the torso and face. Children have a sore throat or mouth pain and may refuse to eat. The sores usually heal quickly.

Depending on which virus causes this disease, children rarely develop central nervous system infections such as aseptic meningitis or encephalitis.

A strain of coxsackievirus that causes atypical forms of hand-foot-and-mouth disease can cause the sores to appear on different parts of the body. The sores vary in size and sometimes are severe. Aseptic meningitis may also occur with these atypical forms, but most people recover completely.


  • A doctor's evaluation

To diagnose hand-foot-and-mouth disease, doctors examine the sores.

Doctors may send samples of material taken from the throat or stool to a laboratory for culture and testing.


  • Good hygiene

A simple and effective way to help prevent hand-foot-and-mouth disease is handwashing. Caregivers should wash their hands after changing diapers. Because most infections that cause hand-foot-and-mouth disease are transmitted by person-to-person contact, particularly through direct or indirect contact with infected stool, good handwashing with soap and water after a bowel movement is an important means of prevention.

Diaper-changing areas should be disinfected with a freshly prepared solution of household bleach (¼ cup [60 mL] bleach diluted in 1 gallon [3.79 L] of water). Frequently touched surfaces and soiled items, including toys, should be cleaned and disinfected.

People should avoid close contact, such as kissing and hugging, and sharing eating utensils or cups with infected people.

There is currently no vaccine against the viruses that cause hand-foot-and-mouth disease.


  • Symptom relief

Treatment of hand-foot-and-mouth disease is aimed at relieving symptoms.

Drugs such as acetaminophen or ibuprofen can relieve pain and fever. (CAUTION: Aspirin should not be given to children because of the risk of Reye syndrome.) Teeth should be brushed gently with a soft toothbrush and rinsed with salt water. People should eat a soft diet and avoid acidic or salty foods. It is important to drink enough liquids to avoid dehydration, even if mouth sores are painful.

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