Impetigo vs. Hand Foot and Mouth Disease

Impetigo and Hand Foot and Mouth Disease (HFMD) are highly contagious, spreading through direct contact with the infected person or surfaces carrying the bacteria or virus. However, their implications, treatment approaches, and preventive measures differ significantly due to their distinct etiological agents.

The global prevalence of impetigo is notable, with the World Health Organization estimating that 111 million children in less developed countries are affected by streptococcal impetigo at any time. On the other hand, between 2008 and 2014, China reported over 10 million HFMD cases, with a fatality rate of 0.03%. During this period, the incidence of HFMD in China increased significantly, peaking in 2012.

In this article, you will learn about the key aspects distinguishing impetigo from HFMD, including their causes, symptoms, diagnosis methods, treatment options, and preventive measures. By understanding these differences, caregivers can better recognize and respond to these conditions, ensuring timely and appropriate care for affected children.

1. Cause

Before delving into the specific causes of Impetigo and HFMD, it's crucial to understand that these diseases stem from different pathogens, affecting individuals, particularly children, in diverse ways. Here are the unique etiologies behind these common infections:

Impetigo

Source: NHS

Two types of bacteria primarily cause impetigo: Staphylococcus aureus and Streptococcus pyogenes.

These bacteria can invade the skin through:

• Minor cuts
• Abrasions
• Insect bites
• Any form of skin barrier disruption

However, impetigo can also arise on intact skin, suggesting alternative bacterial invasion and colonization modes. The disease is particularly prevalent in humid environments and crowded conditions where skin-to-skin contact is common, such as in schools and daycare centers.

The risk of developing impetigo increases with pre-existing skin conditions, such as eczema, which can compromise the skin's protective barrier. Notably, the spread of impetigo peaks during the warmer months, reflecting the bacteria's preference for warm, moist conditions.

This bacterial skin infection is more common in children aged 2 to 5 years, although it can affect individuals of any age if the conditions are conducive to bacterial growth and spread​.

Hand, Foot and Mouth Disease (HFMD)

Source: CDC

HFMD is predominantly caused by enteroviruses, with Coxsackievirus A16 being the most common etiological agent. However, other types of enteroviruses can also lead to HFMD, showcasing the disease's viral diversity.

The transmission of HFMD occurs through direct contact with an infected person's saliva, nasal secretions, blister fluid, or stool. Furthermore, the disease can spread through respiratory droplets following a cough or sneeze, emphasizing the ease of transmission in close-contact environments such as childcare settings.

HFMD shows a predilection for younger children, particularly those in daycare, due to their frequent need for diaper changes, their habit of putting their hands in their mouths, and their developing immune systems.

Despite being highly contagious during the initial week of infection, the virus can remain in the body and be shed for weeks after symptoms have subsided, prolonging the risk of spreading the infection. Outbreaks of HFMD are more common in the summer and early autumn in temperate climates and during the rainy season in tropical areas.

2. Symptoms

While both conditions manifest through skin lesions, the nature, location, and associated symptoms can help differentiate them.

Impetigo

Impetigo's hallmark symptom is its red sores or blisters that can appear anywhere on the body but are most commonly found around:

• Nose and mouth
• Hands
• Feet

These sores quickly rupture, oozing fluid, and form a honey-colored crust. Unlike HFMD, impetigo lesions are more superficial and tend to be clustered in affected areas. Impetigo can be itchy but often described as uncomfortable rather than painful.

The condition can spread to other parts of the body or individuals through direct contact with the lesions or indirectly via contaminated objects. Although impetigo primarily affects the skin, systemic symptoms like fever and lymphadenopathy (swollen lymph nodes) are rare but can occur, especially in more severe cases.

Complications, while uncommon, can include:

• Deeper skin infections (cellulitis)
• Kidney problems
• Scarring​

Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease symptoms present with distinct blister-like sores inside the mouth and a rash or blisters on:

• Hands
• Feet
• Buttocks
• Genital area

The oral lesions can lead to significant discomfort, making eating and drinking challenging, particularly for children. The skin rash associated with HFMD is often not itchy, unlike the rashes of many other viral infections.

Before the rash and mouth sores appear, common initial symptoms are:

• Fever
• Sore throat
• Malaise

This helps distinguish HFMD from impetigo, which typically lacks systemic manifestations at onset.

HFMD is generally self-limiting, with symptoms resolving within 7 to 10 days without medical intervention. However, complications, although rare, can include viral meningitis and encephalitis, underscoring the importance of monitoring for severe symptoms​.

3. Diagnosis

The accurate diagnosis of Impetigo and HFMD relies on clinical evaluation, but certain tests can confirm the diagnosis, especially in ambiguous cases. The approach to diagnosing these conditions reflects their differing causes and manifestations.

Impetigo

Diagnosis of impetigo typically begins with a physical examination of the characteristic sores. Healthcare providers can often diagnose impetigo based on the appearance of the red sores and honey-colored crusts.

In cases where the diagnosis is uncertain, or the infection does not respond to initial treatment, a culture of the bacteria from the lesions may be conducted. This involves taking a swab from the fluid that oozes from the sores and sending it to a laboratory to identify the specific bacteria causing the infection.

This step is crucial for ensuring the prescribed treatment is effective against the causative bacteria. Rapidly identifying the bacterial strain can also help manage and prevent the spread of impetigo within communities, especially in settings like schools and daycare centers where children are in close contact​​.

Hand, Foot, and Mouth Disease (HFMD)

HFMD is generally diagnosed based on the clinical presentation of the symptoms, such as the distinctive mouth sores and rash on the hands and feet. Physicians can usually identify the disease through a physical examination of these signs.

However, in some instances, particularly during outbreaks or severe cases, laboratory tests may be conducted to confirm the virus responsible for the condition. These tests can include taking throat swabs, stool samples, or fluid from the blisters and analyzing them for enteroviruses.

Confirming the specific virus causing HFMD can help understand the potential severity of the disease and advise on public health measures to prevent further spread. While there are no specific antiviral treatments for HFMD, confirming the diagnosis helps manage symptoms and prevent complications​​.

4. Treatment Options

The treatment strategies for Impetigo and HFMD differ significantly due to their bacterial vs. viral causes.

Impetigo

The primary treatment for impetigo involves antibiotics to combat the bacterial infection. For localized infections, topical antibiotics applied directly to the sores may suffice. More widespread infections typically require oral antibiotics.

To prevent the infection from returning and reduce the risk of antibiotic resistance, the full course of antibiotics must be completed. In addition to antibiotics, good hygiene practices, such as washing hands frequently and keeping the infected area clean and covered, are recommended to prevent the spread of impetigo.

Infected individuals should also avoid scratching the lesions to prevent the bacteria from spreading to other parts of the body or to other people.

It's important for caregivers and patients to wash clothing, linens, and towels used by the infected person in hot water and to avoid sharing these items until the infection has cleared​​.

Hand, Foot, and Mouth Disease (HFMD)

Since a virus causes HFMD, antibiotics are ineffective against it. Hand, foot, and mouth disease treatment primarily focuses on relieving symptoms and may include over-the-counter pain relievers to reduce fever and alleviate pain from mouth sores and rash.

Hydration is critical, especially if painful mouth sores make it difficult to eat and drink; cold liquids and soft foods can help.

Topical oral anesthetics may also be recommended to reduce the discomfort of mouth sores. Like impetigo, maintaining good hygiene is essential in managing HFMD, including frequent handwashing and avoiding close contact with infected individuals.

Since HFMD is highly contagious, infected individuals should stay home from school or work until symptoms resolve to prevent the spread of the virus​.

Final Words

Impetigo, characterized by honey-colored crust sores, requires antibiotics and hygiene-focused preventive measures. In contrast, HFMD, marked by mouth sores and a rash, is managed through symptom relief and good hygiene practices like handwashing and avoiding close contact with those infected.

Accurate diagnosis is essential to direct appropriate treatment and preventive strategies, highlighting the importance of public health awareness in managing these conditions, particularly in child-centric environments.

Understanding and addressing these diseases can significantly impact public health, underscoring the role of caregivers in early detection and prevention to protect community health.

Frequently Asked Questions

When are children most contagious with Impetigo and Hand, Foot, and Mouth Disease?

Children are highly contagious for Impetigo until blisters and scabs have completely disappeared. With Hand, Foot, and Mouth Disease, contagiousness is highest in the first week of illness, though the virus can be shed for weeks after symptoms resolve.

Can adults get Hand, Foot, and Mouth Disease?

Yes, adults can get Hand, Foot, and Mouth Disease, but it's less common. Adults are often asymptomatic or have milder symptoms compared to children.

What are the long-term effects of Impetigo and Hand, Foot, and Mouth Disease?

Impetigo and Hand, Foot, and Mouth Disease are generally self-limiting and do not lead to long-term effects in healthy individuals. However, complications can arise from Hand, Foot, and Mouth Disease, such as viral meningitis or encephalitis, though these are rare.

Can Hand, Foot, and Mouth Disease and Impetigo lead to dehydration?

Yes, particularly Hand, Foot, and Mouth Disease, as mouth sores may make it painful for a child to drink and eat, potentially leading to dehydration.