Hand, Foot, and Mouth Disease

A 26-year-old woman presents to your clinic with 5 days of burning and tingling lesions that initially began on her hands bilaterally. She denies any recent illness, fevers, or chills. She has no known medical conditions or allergies, and takes no medications or supplements.

Figure 1

Of note, her son had a small lesion develop near his mouth 4 days before this patient’s symptoms developed. His symptoms resolved in 2 days. This patient initially noticed lesions on both hands 5 days ago, then new lesions developed over her face, mouth, and feet. She states the lesions burn and complained of pain when touching objects or walking.

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Physical examination. The patient is alert, pleasant, and is no distress. She is afebrile and her vitals are all normal. Her HEENT, lung, and cardiovascular exam are all unremarkable. There are multiple circular, slightly discolored macular lesions all over the patient’s hands, palms, face, and feet (Figures 1-4) that are very tender to touch. There are no other significant findings upon examination.

Discussion. Hand, foot, and mouth disease is a common, moderately contagious enteroviral infection usually caused by the group A coxsackieviruses (Coxsackie A16 most commonly). Infection is usually spread through direct contact of saliva, nasal discharge, fluid from blisters, or stool. The usual incubation period is 3 to 5 days with the disease running its course in approximately 3 days.

Symptoms can include fever, vesicles on buccal mucosa and tongue, painful macular lesions on the hands, feet, and buttocks. Differential should include herpangina, varicella, primary herpetic gingostomatitis, Rocky Mountain spotted fever, and aphthous stomatitis. Diagnosis is usually made clinically. Culture fluid from a vesicle can isolate the exact enterovirus, but can take 2 to 4 weeks for results.

Treatment. Medication is usually unnecessary but can include NSAIDs or acetaminophen, as well as topical anesthetics (eg, Lidocaine or Xylocaine) for pain control. This patient’s course was significant in that she returned to clinic on day 5 of the disease with a new presentation. She tried lidocaine cream to no avail and was given clobetasol cream at the second visit due to persistent pain and difficulty holding objects and walking. The patient’s lesions began to dissipate on day 7 and pain completely resolved by day 8.

References:

1. O’connor N. Hand, foot, and mouth disease. Essential Evidence Plus. 2013. Available at: http://www.essentialevidenceplus.com/content/eee/309?section=5. Accessed March 2014.
2. Modlin J. Clinical manifestations and diagnosis of enterovirus and parechovirus infections. UpToDate. 2013. Available at: http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-enterovirus-and-parechovirus-infections?source=preview&anchor=H5&selectedTitle=2~15#H5. Accessed March 2014.