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Hand, foot, and mouth disease in Adult
See also in: Oral Mucosal Lesion
Other Resources UpToDate PubMed

Hand, foot, and mouth disease in Adult

See also in: Oral Mucosal Lesion
Contributors: Gabriela Ulloa MD, Loren Krueger MD, Vivian Wong MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Hand-foot-and-mouth disease (HFMD) is an acute, self-limited viral illness characterized by an oral enanthem with accompanying macular, papular, or vesicular rash, notably on the hands, feet, buttocks, genitalia, and thighs. This typically lasts approximately 7-10 days. HFMD is predominantly caused by coxsackieviruses and other Enterovirus species.

HFMD is highly contagious and commonly transmitted in day care centers, schools, summer camps, and hospitals. Transmission of HFMD occurs via the fecal-oral route and through secretions, including secretions of vesicular fluid and nasal / oral fluid. Following infection, individuals can shed the virus via gastrointestinal passage for 4-6 weeks or via the upper respiratory tract for 3 weeks. Outbreaks usually occur from June to October. The incubation period for the virus is approximately 3-6 days.

HFMD primarily affects children, but adults can also develop the disease. Prodromal symptoms may include fever, abdominal pain, fussiness, emesis, and diarrhea. The typical course of infection starts with a mild fever, sore throat and mouth, cough, headache, malaise, diarrhea / vomiting, and occasional arthralgias. One to two days after the start of systemic symptoms, small oral macules can develop into vesicles and ultimately ulcerate. Lesions then develop on the hands, feet, and groin and can eventually become more widespread. Patients may have associated submandibular and cervical lymphadenopathy.

Coxsackievirus A6 (CV-A6) may cause atypical HFMD where more extensive vesicle formation, including on the forearms and in the perioral area, is seen. "Tomato flu" is an atypical presentation of HFMD that has been noted to occur in children in Kerala, India. Tense vesicles of differing sizes are seen on the extremities, including palms and soles. Oral lesions may occur. Coxsackievirus A16 (CV-A16) has been isolated in 2 known cases.

HFMD from enterovirus A71 (EV-A71) can result in uncommon, severe sequelae, including encephalitis, interstitial pneumonia, flaccid paralysis, myocarditis, heart failure, meningoencephalitis, pancreatitis, conjunctival ulceration, and spontaneous abortion. Lesions are more likely to present on atypical sites such as the face, scalp, and ankles or diffusely on the whole body. Some patients may develop persistent myalgia / arthralgia. Complications are more severe under the age of 1 or with EV-A71 infection.

Eczema coxsackium refers to the spread of a coxsackie viral exanthem in an underlying rash, most commonly atopic dermatitis. Widespread vesicles may be seen more frequently in this setting.


B08.4 – Enteroviral vesicular stomatitis with exanthem

266108008 – Hand foot and mouth disease

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Differential Diagnosis & Pitfalls

For oral lesions, consider:
  • Primary herpes gingivostomatitis – 2-4 mm vesicles, erosions, or ulcers are scattered broadly over the area of primary infection or they may coalesce. Cutaneous findings are absent.
  • Herpangina – Almost identical to HMFD in systemic presentation with a flu-like illness and mouth ulcers, but herpangina does not exhibit vesicles on the palms, soles, digits, and other skin sites.
  • Aphthous ulcers – Painful, shallow ulcers on a grayish base without vesicle formation.
  • Streptococcal throat infection
  • Oral candidiasis
For lesions on the hands, consider:
For eczema coxsackium, consider:

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Last Reviewed:04/25/2019
Last Updated:08/30/2022
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Patient Information for Hand, foot, and mouth disease in Adult
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Contributors: Medical staff writer


Hand-foot-and-mouth disease is a suddenly appearing (acute), self-limited viral disease caused by viruses of the enterovirus group, particularly Coxsackievirus A16. The development (incubation) period from infection to symptoms is short, from 3-6 days. The disease is highly contagious and often spreads from child to child and then from child to adult. Spread of the disease occurs by means of direct contact with nasal and/or oral secretions and stool contact. Widespread (epidemic) outbreaks usually occur from June to October.

Complications from hand-foot-and-mouth disease rarely occur, but they may include pneumonia, inflammation of the heart or brain, or miscarriage in pregnant women who become infected.

Hand-foot-and-mouth disease is not related to foot-and-mouth disease seen in animals.

Who’s At Risk

Hand-foot-and-mouth disease most often occurs in infants and children under 10, but teens and adults can also get it. Once a child has been infected, he or she might be immune to a repeat infection by the same virus that caused the first infection, but infection with related viruses can still occur.

Signs & Symptoms

Hand-foot-and-mouth disease begins with fever up to 101 degrees Fahrenheit, sore throat, sore mouth, cough, headache, fatigue, loss of appetite, and, occasionally, joint pain. After 1-2 days, a rash appears.

Small, red areas of the lining of the mouth, tongue, gums, or throat develop into blisters and rapidly form sores with loss of tissue (ulcerations). Lesions develop a shallow, yellow-gray base and a red surrounding area. Lesions on arms and legs (extremities) begin as red, flat spots that produce oval or football-shaped blisters, surrounded with red coloration. Hand and foot lesions are common on the sides and backs of the fingers and toes. Palms and soles may also be affected.

The skin lesions associated with hand-foot-and-mouth disease may be painful.

In about a week, the rash will disappear and your child will feel better.

Self-Care Guidelines

Hand-foot-and-mouth disease is a self-limited viral infection, so it only needs to be treated for bothersome symptoms. To reduce viral spreading, do not rupture blisters. The virus may be present in a person's stool for 1 month. Be careful to avoid passing the infection to other people by practicing good hygiene. Wash your hands and your child's hands frequently, particularly after using the bathroom or diaper changes and before eating.

Although most pregnant women who become infected with hand-foot-and-mouth disease have no symptoms or just a mild illness, a woman infected shortly before delivery could pass the infection to her baby, who may become very ill. Therefore, any infected child should avoid contact with pregnant women, particularly in late pregnancy.

You may choose to keep your child out of school or day care, but it is not clear this will prevent others from becoming infected, as the illness probably infected others before symptoms were noticed.

Acetaminophen (Tylenol) or ibuprofen may be used for fever and pain. (Do not use aspirin for children under 12.)

Be sure your child drinks plenty of fluids to stay well hydrated. The child may tolerate cold milk products better than fruit juices.

When to Seek Medical Care

See your child's doctor if fever is present and is not brought down to normal by medication or if your child has a severe headache, stiff neck, irritability, reduced awareness (lethargy), or if he or she appears very ill.


Blood tests and procedures to identify the cause of the infection (cultures) are not usually done. If the doctor is concerned that the child might be infected with the bacteria Streptococcus (strep infection), a throat culture may be done.

Antibiotics do not help hand-foot-and-mouth disease. The doctor will likely recommend that you give the child fluids and something to relieve the pain.


Bolognia, Jean L., ed. Dermatology, pp.1256, 1273. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.1374, 2051. New York: McGraw-Hill, 2003.
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Hand, foot, and mouth disease in Adult
See also in: Oral Mucosal Lesion
A medical illustration showing key findings of Hand, foot, and mouth disease : Abdominal pain, Diarrhea, Fever, Headache, Nausea/vomiting, Oral ulcers, Oral mucosa, Oral vesicles, Tiny vesicle, Inguinal region, Pharyngitis, Feet or toes
Clinical image of Hand, foot, and mouth disease - imageId=114752. Click to open in gallery.  caption: 'Gray vesicles on the thumb.'
Gray vesicles on the thumb.
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