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Images of hand foot and mouth rash

Hand, foot, and mouth disease (HFMD) is a common infection in children that causes sores called ulcers inside or around their mouth and a rash or blisters on their hands, feet, legs, or buttocks. It can be painful, but it isn't serious.

It’s not the same thing as foot-and-mouth disease, which comes from a different virus and affects only animals..

Hand, Foot, and Mouth Disease Causes and Risk Factors

The viruses that usually cause hand, foot, and mouth are named coxsackievirus a16 and enterovirus 71.

Anyone can have the disease, but children under age 5 are most likely to get it. It tends to spread easily in the summer and fall.

Hand, Foot, and Mouth Disease Symptoms

Early symptoms may include:

Fever
Sore throat
Painful blisters inside a child’s mouth, usually toward the back, or on their tongue
Feeling unwell (malaise)
Loss of appetite
Fatigue
Crankiness

A day or two later, a child might have:

A rash that turns into blisters
Flat spots or sores on their knees, elbows, or buttocks

Mouth sores can make it hurt to swallow. Eating or drinking less than usual could be the only sign of a child’s illness. Be sure they get enough fluids and nutrients.

Hand, Foot, and Mouth Disease Transmission

The viruses that cause HFMD lurk in the fluids in an infected person’s body, including:

Saliva
Mucus from their nose or lungs
Fluid from blisters or scabs
Poop

Hand, foot, and mouth disease spreads through:

Coughing or sneezing
Close contact like kissing, hugging, sharing cups, or sharing utensils
Contact with poop, like when changing a diaper
Touching surfaces with the virus on them

Hand, Foot, and Mouth Disease Diagnosis

Your doctor will ask about your child’s symptoms and look at any sores or rashes. This is usually enough for them to decide if it’s hand, foot, and mouth disease. But they might also swab your child’s throat or take a sample of poop or blood for lab testing.

Hand, Foot, and Mouth Disease Treatment

There’s no cure or vaccine for hand, foot, and mouth disease. Because a virus causes it, antibiotics won’t help. It usually goes away on its own after 7 to 10 days. In the meantime, you can help your child feel better with:

Over-the-counter pain relievers like ibuprofen or acetaminophen or numbing mouth sprays. Don’t use aspirin, because it can cause serious illness in children.
Cold treats like ice pops, yogurt, or smoothies to soothe a sore throat. Avoid juice and soda, which have acids that might irritate sores.
Anti-itch lotion, like calamine, for rashes

Hand, Foot, and Mouth Disease Complications

Serious complications from hand, foot, and mouth disease are rare. Enterovirus 71 is more likely to cause problems than other HFMD viruses.

Complications may include:

Dehydration if mouth sores make it hard to swallow liquids
Swelling of the membranes around the brain and spinal cord (viral meningitis)
Brain swelling (encephalitis)
Swelling of the heart muscle (myocarditis)
Paralysis

Hand, Foot, and Mouth Disease Prevention

Your child is most contagious in the first 7 days of the illness. But the virus can stay in their body for days or weeks and spread through their spit or poop. Take these steps to lower the chance of infection:

Wash your hands carefully, especially after changing a diaper or wiping a child’s nose. Help children keep their hands clean.
Teach kids to cover their mouth and nose when they sneeze or cough. A tissue is best, but the sleeve of their shirt also works.
Clean and disinfect surfaces and shared items like toys and doorknobs.
Don’t hug or kiss someone who has hand, foot, and mouth disease. Don’t share cups or utensils with them.
Don’t send your child to school or day care until their symptoms are gone. Check with your doctor if you think they might still be contagious.

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.

Take a picture of your skin condition with Aysa

Symptom checkers like Aysa can help narrow down possible skin conditions by analyzing a skin photo.

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 any child aged 18 years or younger.)

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

Treatments

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.

Visit Urgency

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.

References

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.

What do hand foot and mouth rashes look like?

The rash usually is not itchy and looks like flat or slightly raised red spots, sometimes with blisters that have an area of redness at their base. Fluid in the blister and the resulting scab that forms as the blister heals can contain the virus that causes hand, foot, and mouth disease.

What does hand foot mouth blisters look like?

Raised spots usually appear on the hands and feet, and sometimes on the thighs and bottom as well. The spots can look pink, red, or darker than surrounding skin, depending on your skin tone. The spots become blisters which appear grey or lighter than surrounding skin and can be painful.

What is mistaken for hand foot and mouth?

Due to its symptoms, hand, foot, and mouth disease can sometimes be mistaken for chickenpox, herpes, or even insect bites.

What does the start of hand foot and mouth look like in adults?

Symptoms of hand, foot, and mouth disease include fever, painful blister-like sores in the mouth, and a rash that may appear as blisters. It is usually a mild disease, and nearly all infected people recover in 7 to 10 days.