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Hand-Foot-and-Mouth Disease (HFMD)


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 (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.

The disease is most common among young children. The course is similar to that of herpangina. (See also Overview of Enterovirus Infections.)

Large outbreaks of disease due to enterovirus 71 (EV-71) have occurred in the Asia-Pacific region since 1997. Disease due to EV-71 is more serious than that due to other enteroviruses.

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

Onychomadesis (painless nail shedding) is common during convalescence. Aseptic meningitis may complicate atypical HFMD, but most patients recover uneventfully.

Infection with EV-71 may be accompanied by severe neurologic manifestations (eg, meningitis, encephalitis, polio-like paralysis). Morbidity and mortality are significantly higher with EV-71 than with coxsackievirus A16 or other enteroviruses. A recent cluster EV-71-associated neurologic disease was noted in the US in 2018 (1).

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).

Three inactivated EV-71 vaccines are currently available in China, but none are yet approved for use in the US. 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.

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