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Hand-Foot-and-Mouth Disease (HFMD)


Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Jun 2023
Topic Resources

Hand-foot-and-mouth disease (HFMD) is a febrile disorder usually caused by coxsackievirus A16, enterovirus 71, or other enteroviruses. Infection causes a vesicular eruption on the hands, feet, and oral mucosa. Atypical HFMD due to coxsackievirus A6 often causes high fever with papulovesicular lesions progressing to vesicobullous lesions and bullae that are widely distributed on the body.

Children have a sore throat or mouth pain and may refuse to eat. Fever is common. Vesicles are distributed over the buccal mucosa and tongue, the palms of the hands and soles of the feet, and, occasionally, the buttocks or genitals; usually, the vesicles of typical HFMD are benign and short-lived.

Manifestations of Hand-Foot-and-Mouth Disease

Atypical HFMD has 4 distinct presentations:

  • Widespread vesiculobullous lesions

  • Eczema coxsackium with lesions concentrated in areas of eczematous skin

  • Gianotti-Crosti type rash (multiple discrete, erythematous flat-topped papules symmetrically distributed on the face, buttocks, and extensor surface of the extremities)

  • Purpuric lesions

The diagnosis of HFMD is usually made clinically.

Treatment of HFMD is symptomatic. It includes meticulous oral hygiene (using a soft toothbrush and salt-water rinses), a soft diet that does not include acidic or salty foods, and topical measures (see treatment of stomatitis Treatment Oral inflammation and ulcers, known as stomatitis, may be mild and localized or severe and widespread. They are invariably painful. (See also Evaluation of the Dental Patient and Gingivitis... read more Treatment ).

Three inactivated EV-71 vaccines are currently available in China, but none are yet approved for use in the United States. Coxsackie A16 vaccines are also in preclinical development.


  • 1. Messacar K, Burakoff A, Nix WA, et al: Notes from the field: enterovirus A71 neurologic disease in children — Colorado, 2018. MMWR Morb Mortal Wkly Rep 67(36): 1017–1018, 2018. doi: 10.15585/mmwr.mm6736a5

  • 2. Huang CC, Liu CC, Chang YC, et al: Neurologic complications in children with enterovirus 71 infection. N Engl J Med 341(13):936-942, 1999. doi:10.1056/NEJM199909233411302

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