Difference between revisions of "Hand-foot-and-mouth disease"

 
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*Similar to [[Herpangina]], but with additional hand/foot lesions
 
*Similar to [[Herpangina]], but with additional hand/foot lesions
  
 +
==Clinical Features==
 +
[[File:Hand Foot Mouth Disease.png|thumb|Typical lesions around the mouth of an 11-month-old boy.]]
 +
[[File:Herpangina2016.jpg|thumb|Oral herpangitic lesions.]]
 
[[File:Coxsackie.jpg||thumb|alt=Hand lesions coxsackie virus.|Hand 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]]
 
[[File:Hand foot and mouth disease on child feet.jpg|thumb|Foot lesions]]
 
+
[[File:Hand Foot Mouth Disease Adult 36Years.jpg|thumb|Hand and foot lesions in an adult.]]
==Clinical Features==
 
 
*Brief prodrome with low [[fever]], anorexia, sore mouth
 
*Brief prodrome with low [[fever]], anorexia, sore mouth
 
*Oral lesions appear 1-2d later
 
*Oral lesions appear 1-2d later
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**Red papules that change to gray vesicles
 
**Red papules that change to gray vesicles
 
*Resolves after 7–10 days
 
*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}}
 
{{Peds Rash DDX}}
 
{{Bullous rashes DDX}}
 
{{Bullous rashes DDX}}
 +
{{Hand Infection DDX}}
  
 
==Evaluation==
 
==Evaluation==
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==Disposition==
 
==Disposition==
 
*Discharge
 
*Discharge
 +
 +
==Complications==
 +
[[File:Post desqum HFMD.JPG|thumb|Post-disease desquamation of nails]]
 +
*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>
  
 
==See Also==
 
==See Also==

Latest revision as of 20:53, 10 September 2020

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

Typical lesions around the mouth of an 11-month-old boy.
Oral herpangitic lesions.
Hand lesions coxsackie virus.
Hand lesions
Foot lesions
Hand and foot lesions in an adult.
  • 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

Differential Diagnosis

Pediatric Rash

Vesiculobullous rashes

Febrile

Afebrile

Hand and finger infections

Evaluation

  • Clinical diagnosis, based on history and physical examination

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[1]
In infants, do NOT use oral lidocaine due to risk of lidocaine toxicity and FDA black box warning[2][3]

Disposition

  • Discharge

Complications

Post-disease desquamation of nails
  • Some children get a desquamation of the nails around 2 weeks afterwards (self resolves)
  • Meningitis and encephalitis are uncommon, yet still possible complications[4]

See Also

References

  1. 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
  2. FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
  3. 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
  4. 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).

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