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Hand, Foot, and Mouth Disease

A common viral illness of childhood causing characteristic rash on hands and feet with mouth ulcers.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease (HFMD) is a viral illness most commonly caused by Coxsackievirus A16 and Enterovirus 71 (EV-71). Less common causes include Coxsackievirus A6 (which can cause more severe disease in adults) and other enteroviruses. The illness is most prevalent in children under 5 years of age but can occur at any age.

Transmission occurs through respiratory droplets, fecal-oral route, contact with skin lesions, and contaminated surfaces. The incubation period is 3-6 days. The illness typically begins with fever, malaise, and sore throat, followed within 1-2 days by characteristic painful oral ulcers (herpangina-like) and a vesicular rash on hands, feet, and sometimes buttocks.

Most cases are self-limited and resolve within 7-10 days without complications. EV-71 is associated with more severe disease including aseptic meningitis, encephalitis, acute flaccid paralysis, and pulmonary edema. Coxsackievirus A6 outbreaks have been linked to atypical, more widespread rashes and onychomadesis (nail shedding) weeks after recovery.

Symptoms

Fever (typically low to moderate, 38-39°C)
Sore throat and decreased oral intake
Painful oral ulcers (tongue, gums, inner cheeks)
Vesicular rash on palms and soles (3-7 mm gray-white vesicles)
Rash on buttocks, perineum, knees, elbows (especially Coxsackie A6)
Drooling due to painful swallowing
Loss of appetite and irritability
Headache and malaise
Sometimes vomiting or diarrhea
Onychomadesis (nail shedding) 4-8 weeks after illness

Risk Factors

Age under 5 years (highest risk group)
Daycare or preschool attendance
Close contact with infected individuals
Late summer and early fall season
Crowded living conditions
Poor hand hygiene
Tropical and subtropical climates (year-round transmission)
Immunocompromised state (more severe disease)
Pregnancy in third trimester (risk of vertical transmission)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • High fever (over 39°C) or fever lasting more than 3 days
  • Signs of dehydration (decreased urine, dry mouth, lethargy)
  • Severe oral pain preventing fluid intake
  • Headache, neck stiffness, or photophobia (meningitis)
  • Confusion, seizures, or altered consciousness
  • Limb weakness or paralysis (rare EV-71 complication)
  • Difficulty breathing or fast breathing
  • Persistent vomiting
  • Symptoms in pregnant women near term
  • Worsening symptoms or new rash spread

Treatment Methods

01
Supportive care: hydration, rest, comfort
02
Maintain hydration: cold fluids, popsicles, ice chips
03
Avoid acidic, spicy, or salty foods that irritate mouth ulcers
04
Soft, bland diet during illness
05
Topical oral analgesics: lidocaine viscous (use with caution in young children)
06
Antipyretics: acetaminophen or ibuprofen for fever and pain
07
Avoid aspirin in children (Reye syndrome risk)
08
Magic mouthwash: combinations of antacid, diphenhydramine, lidocaine for severe ulcers
09
Hand hygiene: frequent handwashing, especially after diaper changes
10
Disinfect contaminated surfaces and toys
11
Isolation: keep child home from school/daycare while febrile and lesions weeping
12
Hospitalization: severe dehydration, neurological symptoms, suspected EV-71 complications
13
IVIG and steroids: case reports for severe EV-71 neurological disease
14
No specific antiviral therapy (pleconaril not widely available)
15
Education: virus shedding in stool can persist for weeks; hand hygiene critical
16
Pregnant women: discuss with obstetrician if exposure near term

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.