Recognizing and Treating Hand, Foot, and Mouth Disease (With Pictures)

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When it comes to hand, foot, and mouth disease (HFMD), the name seems to say it all - or does it? HFMD causes blistering rashes and sores on the hands, feet, and inside of the mouths of people who catch it. But despite its obvious-sounding name, this common childhood illness causes plenty of confusion.

To confuse matters further, several different viruses can cause HFMD. And the symptoms can be slightly different, depending on which virus you get. Plus, like all viruses, the germs that cause HFMD are always changing. In recent years, new HFMD-causing viruses have appeared around the world.

Keep reading to learn the story behind HFMD, what it looks like, and what to do if you think you or your child has been exposed.

What is hand, foot, and mouth disease (HFMD)?

HFMD is a highly contagious disease that causes fever, cold symptoms, painful mouth sores, and a blistering rash.

HFMD is caused by viruses that spread easily in the air and on surfaces. These viruses can pass from one person to another (for example, from feces, as can happen after changing diapers) and through water.

HFMD is most common in babies and children under the age of 3. But older children and adults can get it too, if they haven't built up immunity to the viruses that cause HFMD.

HFMD spreads most widely in warm weather. Scientists believe this could be because higher humidity allows the virus to travel more easily through the air in water droplets. In the northern part of the U.S., this means HFMD is around from late spring until early fall. In places that stay warm all year, HFMD is around all year.

HFMD can be easily confused with other illnesses:

• It's sometimes called coxsackie disease, because one of the germs that causes it is the coxsackie virus. Don't confuse this with Kawasaki disease, a completely different condition.

• It's not the same as hoof-and-mouth (or foot-and-mouth) disease. Hoof-and-mouth is a veterinary disease that affects sheep, cows, and goats. It's not related to HFMD at all.

What causes hand, foot, and mouth disease?

HFMD happens when one of the HFMD-causing viruses enters your body and starts to multiply.

The most common viruses linked to HFMD are:

• Enterovirus A71

• Coxsackievirus A6

• Coxsackievirus A16

• Coxsackievirus A10

Other related viruses, such as coxsackievirus A4, coxsackievirus A9, and echovirus 6, can also cause HFMD. All of these viruses are in the Enterovirus family.

In 2008, an outbreak of hand, foot, and mouth disease in Finland was especially severe. When people were tested, it turned out they had been infected with a new strain of the Enterovirus, called coxsackievirus A6. These days, the coxsackievirus A6 variant is becoming a more common cause of HFMD around the world. It tends to cause a more severe illness than some other strains.

Stages and symptoms of hand, foot, and mouth disease?

Symptoms are typically the same in adults and children. While the disease is usually not serious, symptoms can be very uncomfortable while they last.

Incubation stage

Once infected with one of the viruses that cause HFMD, it can take between 3 to 6 days for symptoms to appear. People can shed the virus before they develop the symptoms, which is part of what makes the infection so contagious.

First stage

The first symptoms of HFMD to appear tend to be:

• A sore throat, although this may just show up as fussiness or irritability in young children

• A fever

• A runny nose

• Drooling

• Not wanting to eat

Second stage

A few days later, a rash and mouth sores will start to appear. Look out for the following symptoms:

• Painful mouth sores will appear, especially on your tongue, the back of your mouth, and your throat.

• Small skin spots or bumps that can turn into blisters on your hands and feet, and around your mouth and chin. They can be pink (in lighter skin tones) or violet and skin-colored (in darker skin tones)

• Eventually, blisters can break and form open sores.

• The rash may also affect your groin area and bottom.

The first and second stages of HFMD usually last between 1 and 2 weeks.

Later stages

With a newer version of the HFMD virus known as coxsackievirus A6, later symptoms are common and include:

• Peeling of the palms of your hands and feet, 1 to 3 weeks after the initial illness

• Nail damage, including ridges (Beau lines) and nail peeling, which can happen 1 to 2 months after the initial illness

Rare complications

Rarely, HFMD-causing viruses can trigger neurologic symptoms. In these cases, the illness affects your brain (resulting in encephalitis) or the areas around your brain (resulting in meningitis or meningoencephalitis).

Here's how these life-threatening complications may show up in young children:

• Muscle twitching

• Acting jumpy when startled

• Drowsiness or sleepiness

• Feeling floppy or weak

• Seizures

These symptoms are most often linked to a certain variant called enterovirus A71. In some parts of the world, especially in east Asia, this is the most common cause of HFMD. It's less common in the U.S. and Europe.

What does HFMD look like?

Here are some pictures of the different stages of HFMD.

How is hand, foot, and mouth disease treated?

There's no specific treatment for HFMD. Over-the-counter (OTC) pain relievers and fever reducers, like acetaminophen (Tylenol) or ibuprofen (Advil or Motrin), can help with symptoms. If dehydration is a concern for you, you might benefit from (intravenous) IV fluids in the hospital.

Severe symptoms, including neurologic symptoms, require treatment by a specialist. Antiviral medications or IV immune globulin (IVIG) are sometimes used.

How can I prevent hand, foot, and mouth disease?

The viruses that cause HFMD spread easily from people who are sick. Your best protection is to stay away from anyone who is experiencing symptoms. And if your child is sick, keep them home and away from others.

Preventing infection isn't always easy. If your young child has HFMD, it might be difficult for you to stay completely clear of their body fluids. Wash your hands often, and make sure you use clean dishes when you serve food. If your child has been sick, don't eat off the same utensils - especially if you're immunocompromised.

In the future, a vaccine will be the best way to prevent HFMD. Since 2015, a vaccine against enterovirus A71 has been available in China, and researchers around the world are working to develop a vaccine against the other viruses that cause HFMD.

Frequently asked questions

Images used with permission from VisualDx (www.visualdx.com).

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