Hand-foot-and-mouth disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 5 Aug 2025

Last updated: 11 Aug 2023

Hand-foot-and-mouth disease is a highly contagious childhood viral infection.

Diagnosis is usually clinical, based on a typical history and characteristic clinical features.

Infection typically resolves spontaneously within 10 to 14 days, and treatment is mainly supportive.

In East and Southeast Asian countries, enterovirus 71 (EV71) is responsible for a more severe version of the disease with serious complications; however, this is uncommon in the US and Europe.

Definition

A common childhood viral infection that is most commonly caused by a coxsackievirus in the US, characterized by low-grade fever, painful oral ulcers, and vesicles on the hands and feet. The disease has no relation to foot-and-mouth disease, which affects cattle and other cloven-hoofed animals.

History and exam

Key diagnostic factors

low-grade fever
oral vesicles and ulcers
rash and/or vesicles on the hands and feet

Full details

Other diagnostic factors

malaise
sore mouth
loss of appetite
sore throat
rash and/or vesicles on the buttocks
abdominal pain
diarrhea
cough
tongue erythema/edema
arthralgia

Full details

Risk factors

immunosuppression
age <10 years
family or school contacts with infection

Full details

Diagnostic tests

Tests to consider

viral culture
CBC

Full details

Emerging tests

PCR molecular assays

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Malobi I. Ogboli, MBBS, FRCP

Consultant Dermatologist

Birmingham Children's Hospital and Birmingham City Hospital

Birmingham

Disclosures

MIO declares that she has no competing interests.

Peer reviewers

Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed

Consultant Paediatrician

Heartlands Hospital

Birmingham

Disclosures

HG declares that she has no competing interests.

Andrew Riordan, MD, FRCPCH, MRCP, DTM&H

Consultant in Paediatric Infectious Diseases and Immunology

Royal Liverpool Children's Hospital (Alder Hey)

Liverpool

Disclosures

AR declares that he has no competing interests.

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

Disclosures

DC declares that he has no competing interests.

Leonid Izikson, MD

Staff Dermatologist

Department of Dermatology

Massachusetts General Hospital

Boston

Disclosures

LI declares that he has no competing interests.

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

Disclosures

AS declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Alsop J, Flewett TH, Foster JR. "Hand-foot-and-mouth disease" in Birmingham in 1959. Br Med J. 1960;2:1708-1711.Full text Abstract

Ishimaru Y, Nakano S, Yamaoka K, et al. Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system. Arch Dis Child. 1980;55:583-588.Full text Abstract

Saguil A, Kane SF, Lauters R, et al. Hand-foot-and-mouth disease: rapid evidence review. Am Fam Physician. 2019 Oct 1;100(7):408-14.Full text Abstract

Chang LY, Tsao KC, Hsia SH, et al. Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan. JAMA. 2004;291:222-227.Full text Abstract

Chang LY, Lin TY, Huang YC, et al. Comparison of enterovirus 71 and coxsackie-virus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998. Pediatr Infect Dis J. 1999;18:1092-1096. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Aphthous stomatitis or oral aphthous ulcers
- Herpes simplex
- Herpangina
More Differentials
Guidelines
- A guide to clinical management and public health response for hand, foot and mouth disease (HFMD)
More Guidelines
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Hand-foot-and-mouth disease

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

Tests to consider

Emerging tests

Treatment algorithm

all patients

Contributors

Authors

Malobi I. Ogboli, MBBS, FRCP

Disclosures

Peer reviewers

Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed

Disclosures

Andrew Riordan, MD, FRCPCH, MRCP, DTM&H

Disclosures

David Cassarino, MD, PhD

Disclosures

Leonid Izikson, MD

Disclosures

Aisha Sethi, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice