Hand-Foot-and-Mouth Disease in Emergency Medicine Clinical Presentation

Updated: Oct 02, 2018
  • Author: Pamela L Dyne, MD; Chief Editor: Russell W Steele, MD  more...
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The usual incubation period of hand-foot-and-mouth (HFM) disease is 4-6 days.

The prodrome is associated with the following:

  • Low-grade fever

  • Malaise

  • Anorexia

  • Abdominal pain

  • Sore mouth

The prodrome precedes the development of oral lesions, followed shortly by skin lesions, primarily on the hands and feet and occasionally on the buttocks.



Hand-foot-and-mouth disease is the most common cause of mouth sores in pediatric patients.

Yellow ulcers surrounded by red halos characterize the oral lesions. These primarily occur on the labial and buccal mucosal surfaces but may be observed on the tongue, palate, uvula, anterior tonsillar pillars, or gums. Unlike herpetic gingivostomatitis, perioral lesions are uncommon. Coxsackie A virus also causes herpangina, mostly described as palatal and posterior oropharyngeal lesions without any associated exanthem. The oral ulcers are painful. Children younger than 5 years are predominately more symptomatic than older patients. [5]

The exanthem typically involves the dorsal surfaces but frequently may include the palmar, plantar, and interdigital surfaces of the hands and feet. These lesions may be asymptomatic or pruritic. They usually begin as erythematous macules that rapidly progress to thick-walled grey vesicles with an erythematous base. In young infants, these lesions may also be observed on the trunk, thighs, and buttocks. The rash is usually self-limited, lasting approximately 3-6 days. Case reports have documented subacute, chronic, and recurring skin lesions.



See the list below:

  • The enteroviruses, specifically coxsackievirus A16, A-10, and A-5 predominate.