Hand, Foot, and Mouth Disease (Coxsackievirus)


5-year-old boy presents to the Emergency Department with low-grade fever and lesions on his hands and feet. Mom notes that two other kids in his kindergarten class have a similar rash. She also noticed ulcers on his tongue and inner inner cheeks. 


  • most cases affect children younger than 10-years-old
  • tends to occur during the summer-fall


  • Coxsackievirus A16
  • Enterovirus 71

Clinical Findings

    • mouth: mucositis, vesicles on buccal mucosa, tongue, palate, uvula, or tonsillar pillars 
    • hands: tender vesicular lesions on the palms and back (dorsum) of hands which may form bullae ulcerate  
    • feet: including the soles


  • based on clinical findings above


  • Isolation - highly infectious
  • Supportive therapy (hydration maintenance with fever and pain control)
  • Painful oral ulcers can be treated with topical oral anesthetics
    • Magic Mouthwash - 2% viscous lidocaine, Benadryl, and Maalox 
    •  20% topical benzocaine (Orabase)
  • Fever and Joint Pains
    • Acetaminophen or NSAIDs/cyclooxygenase (COX)-2's
    • AVOID ASPIRIN viral illnesses in children younger than 12 years of age, to prevent Reye syndrome.


  • Self-limited - resolves in 2 to 3 days after the appearance of rash 


  • See my video on vesicular rashes below for a quick review
  • The color-coded highlighting is as follows:
    • Green - the diagnosis or disease process
    • Orange - key features and buzzwords
    • Blue - management and treatment

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Feb. 20, 2018

Great article! I love the photos you've included, they really help me remember things. And a million complements for that awesome music video.

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Feb. 20, 2018

thank you.. there will be a lot more to come. 


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