Hand-foot-and-mouth disease

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

Last reviewed: 30 Sep 2024

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.

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
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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

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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