[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Hand, foot and mouth disease [Conditions](https://durgical.com/en/conditions/) · [Pediatrics and neonatology](https://durgical.com/en/conditions/) # Hand, foot and mouth disease A common enterovirus infection of young children with fever, painful mouth sores and small blisters on the hands and feet. Usually mild; watch for dehydration. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Tongue](https://durgical.com/en/anatomy/tongue/) - [Skin](https://durgical.com/en/anatomy/skin/) - [Soft palate](https://durgical.com/en/anatomy/soft-palate/) - [Pharynx](https://durgical.com/en/anatomy/pharynx/) ## Microorganisms that cause it - [Enteroviruses](https://durgical.com/en/microbiology/enteroviruses/) ## Why it happens - [Where blisters form: pemphigus vs pemphigoid](https://durgical.com/en/histology/where-blisters-form-pemphigus-vs-pemphigoid/) ## What it is A contagious viral illness, mostly of children under 5, caused by enteroviruses. It produces fever, painful ulcers in the mouth and a vesicular rash on the palms, soles and often the buttocks. It is usually self-limited in 7–10 days. ## Who gets it Worldwide, with outbreaks in nurseries and day-care centres, peaking in warm or rainy seasons. Outbreaks in day-care centres and schools are common in Colombia and the rest of Latin America; large epidemics with neurological cases have occurred in Asia with enterovirus A71. ## Causes - Coxsackievirus A16 is the classic cause; coxsackievirus A6 causes more widespread, atypical rashes - Enterovirus A71 is linked to more severe neurological and cardiopulmonary disease - Spread by respiratory droplets, saliva, blister fluid and the faecal-oral route; stool can shed virus for weeks ## Risk factors - Age under 5 years - Day-care or nursery attendance - Close household contact with a case - Poor hand hygiene and nappy-changing practices ## Pathophysiology The virus replicates in the [pharynx](https://durgical.com/en/anatomy/pharynx/) and gut, spreads through the blood and seeds the [skin](https://durgical.com/en/anatomy/skin/) and oral mucosa, where it forms vesicles that break into shallow ulcers. In a few cases, mainly with enterovirus A71, it invades the brainstem and [spinal cord](https://durgical.com/en/anatomy/spinal-cord/), causing encephalitis, flaccid paralysis or neurogenic pulmonary oedema. ## Classification - Typical hand, foot and mouth disease - Atypical (coxsackievirus A6): widespread vesicles, eczema-associated lesions, later nail shedding - Complicated: neurological or cardiopulmonary involvement ## Symptoms and signs - Fever, poor appetite, sore throat and irritability - Painful ulcers on the [tongue](https://durgical.com/en/anatomy/tongue/), gums, inner cheeks and palate; drooling and refusal to drink - Small oval vesicles on a red base on the palms and soles - Red papules or vesicles on the buttocks, knees or genital area - Peeling of fingernails or toenails weeks later ## Red flags - Signs of dehydration: few wet nappies, dry mouth, lethargy - Persistent high fever, vomiting, myoclonic jerks, ataxia or drowsiness (possible encephalitis) - Limb weakness (acute flaccid paralysis) - Fast breathing, tachycardia, poor perfusion or pink frothy sputum (cardiopulmonary failure) - Seizures ## Diagnosis **Clinical** Clinical: the age, the mouth ulcers and the distribution of the rash on hands and feet are usually enough. Assess hydration status. **Tests** Not needed in typical cases. Enterovirus PCR of throat swab, stool, vesicle fluid or cerebrospinal fluid in severe cases or outbreaks; lumbar puncture if central [nervous system](https://durgical.com/en/anatomy/system/nervous-system/) involvement is suspected. **Imaging** Brain and spinal MRI when encephalitis or flaccid paralysis is suspected; [chest](https://durgical.com/en/anatomy/region/chest/) X-ray and echocardiography in cardiopulmonary deterioration. ## Differential diagnosis - Herpetic gingivostomatitis (herpes simplex) - Herpangina (ulcers only at the back of the mouth) - Varicella - Aphthous ulcers - Measles or drug eruptions ## Goal of treatment Control pain and fever, keep the child well hydrated, prevent spread and recognise neurological or cardiopulmonary complications early. ## Treatment **Conservative** Supportive care: paracetamol or ibuprofen for fever and pain, cold soft foods and frequent sips of fluid; avoid acidic drinks. Antibiotics do not help, and aspirin is avoided in children. **Acute** Oral rehydration solution, or intravenous fluids if the child cannot drink. **Follow-up** Nursing: monitor intake, urine output, temperature and level of consciousness; teach caregivers the warning signs. **Acute** Severe enterovirus A71 disease needs intensive care, with supportive management and, in some centres, intravenous immunoglobulin. ## Complications - Dehydration from painful swallowing - Febrile seizures - Viral (aseptic) meningitis and brainstem encephalitis - Acute flaccid paralysis - Myocarditis and neurogenic pulmonary oedema (mainly enterovirus A71) - Nail shedding (onychomadesis) ## Prognosis Most children recover fully within 7–10 days. Death is rare and is almost always linked to enterovirus A71 with brainstem involvement. ## Prevention - Hand washing after nappy changes and toilet use - Cleaning shared toys and surfaces - Keeping sick children home while febrile and with open mouth sores - Inactivated enterovirus A71 vaccines are used in some Asian countries; none is available in Colombia ## Test yourself Think of the answer, then tap the question to see it. ## What is the classic virus causing hand, foot and mouth disease? Coxsackievirus A16 (an enterovirus). ## Which enterovirus is linked to severe neurological disease? Enterovirus A71. ## What is the main nursing priority in a toddler with painful mouth ulcers? Preventing dehydration: encourage fluids, control pain and monitor urine output. ## How does herpangina differ from hand, foot and mouth disease? Herpangina has ulcers only on the posterior oropharynx and soft palate, with no hand and foot rash. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/hand-foot-and-mouth-disease/) ## Related conditions - [Genital herpes (herpes simplex infection)](https://durgical.com/en/conditions/genital-herpes/) - [Varicella (chickenpox)](https://durgical.com/en/conditions/varicella/) - [Febrile seizures](https://durgical.com/en/conditions/febrile-seizures/) - [Viral encephalitis (herpes simplex encephalitis)](https://durgical.com/en/conditions/viral-encephalitis/) - [Measles](https://durgical.com/en/conditions/measles/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Hand-foot-mouth disease](https://medlineplus.gov/ency/article/000965.htm) (MedlinePlus (U.S. National Library of Medicine), 2025); [About Hand, Foot, and Mouth Disease](https://www.cdc.gov/hand-foot-mouth/about/index.html) (Centers for Disease Control and Prevention (CDC), 2024). 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