Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease (HFMD) is a highly contagious viral infection caused by viruses of the enterovirus family, commonly affecting children under five years of age. It typically presents with characteristic lesions on the skin and mucous membranes, most often due to Coxsackievirus A16 or Enterovirus 71. Although more frequently observed in spring and summer months, it is also reported in autumn and winter due to climate changes and increased travel. The disease usually follows a mild course and resolves spontaneously with symptomatic treatment; however, it must be carefully evaluated due to the potential for rare but serious complications.

Although HFMD is most commonly associated with Coxsackievirus A16, other enterovirus types such as Coxsackievirus A5, A7, A9, B1, B3, and Enterovirus 71 can also cause the disease. Enterovirus 71 is particularly notable for its association with neurological complications. The disease primarily affects children under five years of age but can also occur in older children and rarely in adults. Epidemiological studies show that HFMD occurs most frequently during summer and autumn months.

HFMD is a highly infectious disease. Transmission occurs through direct contact with nasal and throat secretions, feces, or fluid from lesions of infected individuals, or via respiratory droplets. The incubation period is 3 to 7 days. Infectiousness is highest during the first week of illness but can persist for weeks after lesions have resolved.

The onset of the disease is typically marked by nonspecific symptoms such as fever, malaise, anorexia, and sore throat. Within the following days, painful vesicles or aphthous-like lesions develop on the oral mucosa. Oval-shaped, 2–10 mm vesiculopustular rashes with an erythematous halo appear on the hands and feet, particularly on the palmar and plantar surfaces and the inner aspects of the fingers.

• Ventral and lateral surfaces of the fingers and toes
• Palms and soles
• Perioral area and oral mucosa
• Gluteal region, knees, elbows, and rarely the face

Lesions are typically non-pruritic and non-painful and tend to appear simultaneously. Erythematous maculopapular rashes may accompany them. Lesions resolve spontaneously within 7 to 10 days, forming crusts without leaving scars.

Diagnosis is made clinically based on characteristic findings. Specific laboratory testing is generally not required. Differential diagnoses include:

• Varicella
• Erythema multiforme
• Secondary syphilis
• Other viral exanthems
• Vasculitis
• Infected thromboembolism
• Drug eruptions

Although HFMD is usually a mild, self-limiting illness, serious complications can rarely occur. These include:

• Aseptic meningitis
• Encephalitis
• Myocarditis
• Pulmonary edema or hemorrhage
• Acute flaccid paralysis
• Dehydration

Therefore, if systemic signs such as vomiting, altered mental status, respiratory distress, tachycardia, or bradycardia accompany fever, further evaluation is warranted.

There is no specific antiviral treatment for HFMD. Management is primarily supportive. Analgesics and antipyretics may be used for fever, pain, and oral lesions. Oral hygiene is important. Antibiotics are indicated only in cases of bacterial superinfection.

• Emphasis on hand hygiene
• Avoidance of contact with infected individuals
• Disinfection of toys and surfaces
• Do not rupture vesicles

Special precautions are necessary for pregnant women. Infection during the first trimester may increase the risk of miscarriage and fetal anomalies. Therefore, avoidance of contact with pregnant women is important.

Recognition and appropriate management of HFMD at the primary care level help prevent unnecessary referrals and advanced diagnostic testing. Raising public awareness, particularly during outbreaks, is of great importance for public health. Vaccine development efforts have focused primarily on Enterovirus 71, but no widely available vaccine is currently in use.