Hand-foot-and-mouth disease: Difference between revisions
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==Background== | ==Background== | ||
*Caused by coxsackie virus | *Caused by [[coxsackie virus]] | ||
*Most frequently in children, but can occur in all age groups | *Most frequently in children, but can occur in all age groups | ||
*Similar to [[Herpangina]], but with additional hand/foot lesions | |||
[[File:Coxsackie.jpg||thumb|alt=Hand lesions coxsackie virus.|Hand lesions]] | |||
[[File:Hand foot and mouth disease on child feet.jpg|thumb|Foot lesions]] | |||
==Clinical Features== | ==Clinical Features== | ||
*Brief prodrome with low fever, anorexia, sore mouth | |||
*Brief prodrome | |||
*Oral lesions appear 1-2d later | *Oral lesions appear 1-2d later | ||
**Vesicles on erythematous base | **Vesicles on erythematous base, will then ulcerate | ||
**Painful | **Painful | ||
**Found on buccal mucosa, tongue, soft palate and gingiva | |||
*Hand/foot lesions | *Hand/foot lesions | ||
**Red papules that change to gray vesicles | **Red papules that change to gray vesicles | ||
*Resolves after 7–10 days | |||
===Complications=== | |||
*Some children get a desquamation of the nails around 2 weeks afterwards (self resolves) | |||
*Meningitis and encephalitis are uncommon, yet still possible complications<ref>Bonfante G and Rosenau AM. Rashes in Infants and Children: in Tintinalli JE, Stapczynski S, et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, ed 7. McGraw-Hill, 2011. Ch (134).</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peds Rash DDX}} | |||
{{Bullous rashes DDX}} | |||
== | ==Evaluation== | ||
* | *Clinical diagnosis, based on history and physical examination | ||
**If unsure, see [[Pediatric Fever]] | **If unsure, see [[Pediatric Fever]] | ||
| Line 25: | Line 33: | ||
==Disposition== | ==Disposition== | ||
* | *Discharge | ||
==See Also== | ==See Also== | ||
| Line 32: | Line 39: | ||
*[[Pediatric Rashes]] | *[[Pediatric Rashes]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | ==Video== | ||
{{#widget:YouTube|id=kK1Dpk9bHmM}} | |||
[[Category:Dermatology]] | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Pediatrics]] | ||
Revision as of 15:59, 7 September 2016
Background
- Caused by coxsackie virus
- Most frequently in children, but can occur in all age groups
- Similar to Herpangina, but with additional hand/foot lesions
Clinical Features
- Brief prodrome with low fever, anorexia, sore mouth
- Oral lesions appear 1-2d later
- Vesicles on erythematous base, will then ulcerate
- Painful
- Found on buccal mucosa, tongue, soft palate and gingiva
- Hand/foot lesions
- Red papules that change to gray vesicles
- Resolves after 7–10 days
Complications
- Some children get a desquamation of the nails around 2 weeks afterwards (self resolves)
- Meningitis and encephalitis are uncommon, yet still possible complications[1]
Differential Diagnosis
Pediatric Rash
- Atopic dermatitis
- Bed bugs
- Contact dermatitis
- Drug rash
- Erythema infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-schonlein purpura (HSP)
- Herpangina
- Herpes simplex virus (HSV)
- Infectious mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella (German measles)
- Scabies
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella (chickenpox)
- Smallpox
- Monkeypox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Bullous impetigo
- Localized distribution
- Contact dermatitis
- Herpes zoster (shingles)
- Dyshidrotic eczema
- Burn
- Dermatitis herpetiformis
- Erythema multiforme minor
- Poison Oak, Ivy, Sumac dermatitis
- Bullosis diabeticorum
- Bullous impetigo
- Folliculitis
Evaluation
- Clinical diagnosis, based on history and physical examination
- If unsure, see Pediatric Fever
Management
- No specific therapy for most; self-limited
- NSAIDS and cool liquids for pain
- Encourage good hand hygiene to prevent spread
- Some recommend Magic Mouthwash/oral lidocaine if not tolerating PO intake, although evidence suggests no better than placebo[2]
- In infants, do NOT use oral lidocaine due to risk of lidocaine toxicity and FDA black box warning[3][4]
Disposition
- Discharge
See Also
References
- ↑ Bonfante G and Rosenau AM. Rashes in Infants and Children: in Tintinalli JE, Stapczynski S, et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, ed 7. McGraw-Hill, 2011. Ch (134).
- ↑ Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9
- ↑ FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
- ↑ Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39
Video
{{#widget:YouTube|id=kK1Dpk9bHmM}}