Hand-Foot-and-Mouth Disease Symptoms, Causes & Treatment Options

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  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Hand-Foot-and-Mouth Disease?


Hand-foot-and-mouth disease is a common viral illness that usually affects young children and sometimes affects adults. It is most frequently caused by the coxsackievirus, though other related viruses can be responsible as well. These viruses are present worldwide in all seasons, and they are highly contagious through fecal matter, saliva, mucus, and other secretions. The disease characteristically presents with blisters and bumps on the hands and feet, and sores in the mouth, as well as fevers, malaise, sore throat, runny nose, and more generalized rashes. Most cases of hand-foot-and-mouth disease are self-limiting and last 7-14 days. Discomfort from the disease can be treated with regular Tylenol and analgesic mouthwashes, and transmission can be limited by good hand hygiene and disinfection of surfaces.

Recommended care

Hand-Foot-and-Mouth Disease Symptoms

Classic symptoms

The defining features of coxsackievirus infection are described below. Though named for the hand-foot-and-mouth rash, infection with coxsackievirus and the related family of enteroviruses can vary in its presentation. Any combination of the features described below is possible, and it is not required that hands, feet, or mouth be affected at all.

  • Hands: Oval vesicles (fluid-filled, blister-like bumps) and red to purple-colored macules (flat spots) can appear on the palms of the hands.
  • Feet: Oval vesicles (fluid-filled, blister-like bumps) and red to purple-colored macules (flat spots) can also appear on the soles of the feet.
  • Mouth: Pale, round, and oval erosions (shallow holes) may be present on the insides of the mouth, that can resemble canker sores (apthous ulcers). Additionally, vesicles and crusts may form around the mouth on the lips, nose, and surrounding skin.

Other skin manifestations

Additional skin manifestations of hand-foot-and-mouth disease can include the following:

  • Genitals: An eruption of papules (red bumps) vesicles, and erosions may occur in the genital region during coxsackievirus infection.
  • Viral exanthem: A viral exanthem is a generalized rash that accompanies a viral infection. In cases of enterovirus or coxsackievirus infection (the viruses that cause hand-foot-and-mouth disease), the exanthema will often look like a diffuse scattering of red vesicles, blisters, and flat and raised spots, that can affect the extremities and to a lesser extent, the trunk.
  • Eczema coxsackium: In people with a history of eczema or other dermatitis, the coxsackievirus exanthema may appear predominantly in areas previously affected by eczema [1].
  • Fingernail loss: Occasionally, children will lose finger or toe nails after a hand-foot-and-mouth infection has cleared. This is normal and does not require additional treatment.

Systemic symptoms

Beyond its characteristic rash, hand-foot-and-mouth disease behaves much like other viruses, causing a generalized illness that can include the following symptoms:

  • Fever and malaise
  • Respiratory symptoms: A sore throat and runny nose are most common.
  • Gastrointestinal symptoms: may include stomach pain, indigestion, and diarrhea
  • Meningitis: Rarely the virus can cause an inflammation of the tissues surrounding the brain.
  • Joints and muscles: This and other viruses can cause aches and pains.

Hand-Foot-and-Mouth Disease Causes

Hand-foot-and-mouth disease is a viral infection most commonly caused by the coxsackievirus. Specific coxsackievirus variants A16 and A6 are leading causes of hand-foot-and-mouth disease. It is also possible to get hand-foot-and-mouth disease by becoming infected with a relative of the coxsackievirus, like enterovirus or echovirus for example. Enterovirus 71 is a less common cause of hand-foot-and-mouth disease that is more likely to cause complications like meningitis [1].

Coxsackievirus, other enteroviruses, and echoviruses are all in a category of viruses called picornaviruses. These viruses are present all over the world, and can be infectious in any season, though peak season is summer and fall, in temperate climates.

Coxsackievirus and its relatives can be spread in several ways, listed below:

  • Fecal-oral transmission: This means that you can catch these viruses from improper hand-washing and swimming pools. The virus can be shed in the stools of affected individuals for several weeks after symptoms clear [2].
  • Respiratory transmission: Coxsackieviruses and related enteroviruses can be spread by sharing a space with someone who is coughing or sneezing, or by coming into contact with their saliva, mucous and breath.
  • Secretions: Additionally, fluid from the blisters can be contagious, and the virus can persist on surfaces for extended periods of time.
  • Asymptomatic transmission: After transmission, the viruses causing hand-foot-and-mouth disease generally have an incubation period of 3-6 days, during which affected individuals can be asymptomatic and contagious. Adults are especially likely to be asymptomatic carriers of coxsackievirus.

Young children (under age 5) are the most likely to be infected with coxsackievirus and hand-foot-and-mouth disease, and the virus is easily spread in a childcare setting. Large scale outbreaks have been documented in Asia, but are infrequent in the United States [3].

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Treatment Options, Relief, and Prevention for Hand-Foot-and-Mouth Disease


Diagnosis of hand-foot-and-mouth disease is clinical, meaning that your doctor will use your history, and a physical examination to determine if the disease is present. If there is some uncertainty, the doctor may swab blisters to rule out other causes of the rash or other viruses [2]. Once hand-foot-and-mouth disease is diagnosed, it can be treated as follows:

  • Self-limiting: Hand-foot-and-mouth is a fairly minor viral infection that will almost always resolve within 7-14 days. For the most part, no treatment is necessary.
  • Mouth symptoms: Painful mouth sores can be treated symptomatically. A topical oral anesthetic, like benzocaine lozenges, may be effective for mouth sores. Another option is a gargled mixture of liquid acetaminophen (Tylenol) and diphenhydramine (Benadryl) to coat and soothe ulcers [2].
  • Fevers and malaise: Fevers and malaise can also be treated symptomatically with acetaminophen (Tylenol).
  • Don’t give aspirin: It is very important to avoid aspirin use in children, as this can cause a deadly injury called Reye Syndrome.
  • Antivirals: When very severe cases develop complications like meningitis, antiviral medications (like Ribavirin, quinacrine, and amantadine) have been effective in experimental settings [2].


Hand-foot-and-mouth disease is a highly contagious infection that (as mentioned above) can be spread through any contact with fecal or respiratory particles, as well as through draining blisters and bumps. Since this disease often affects children and childcare settings, prevention efforts are key to limit the scope of outbreaks. Take the following steps to limit the spread of hand-foot-and-mouth disease:

  • Hand washing: Wash hands thoroughly, with an antimicrobial soap after using the bathroom, changing diapers, before eating, and before preparing food. Take the time to learn proper handwashing techniques, and teach good technique to anyone old enough to learn.
  • Disinfecting: Coxsackievirus and its relatives can live off of the body on toys and surfaces. Use disinfectant wipes or dilute bleach to disinfect these surfaces often when infections are occurring.
  • Isolate: Hand-foot-and-mouth disease is very contagious, so make efforts to keep kids at home when they are ill, if possible [4].

When to Seek Further Consultation for Hand-Foot-and-Mouth Disease

Hand-foot-and-mouth disease is generally self-limited and should resolve within 7 to 14 days, so treatment from a doctor is not always necessary.

You should seek consultation with a pediatrician, internist, or dermatologist in most cases to establish a diagnosis, and to rule out more dangerous viral infections (like chicken pox or measles) that can closely resemble hand-foo-mouth disease.

You should seek emergent medical care if you or a child is experiencing severe head or neck aches in the setting of hand-foot-and-mouth disease. This is an indication of possible meningitis of encephalitis, both of which can be life-threatening in the worst cases.