Hand-foot-and-mouth disease

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  • Caused by coxsackie virus
  • Most frequently in children, but can occur in all age groups
  • Similar to Herpangina, but with additional hand/foot lesions
Hand lesions coxsackie virus.
Hand lesions
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


  • 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

Vesiculobullous rashes




  • Clinical diagnosis, based on history and physical examination


  • 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]


  • Discharge

See Also


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