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Hand, Foot & Mouth Disease

by Sue Hubbard, M.D.

They say a picture is worth a thousand words and I believe it, especially as it pertains to rashes and pediatric illnesses. My iPhone has become a handy tool in educating parents in my practice, online and via social media.

It seems rather late in the season for Coxsackie virus to be occurring (typically more late summer early fall) but I am seeing so many little patients with the classic skin findings of “hand-foot and mouth” disease (HFM).  Some of the cases have been so classic that I took pictures of the rash, as once you see HFM you tend to know it!  Unfortunately, you may see this rash and think you won’t see it again, but you can get HFM more than once, so you will definitely know what you are dealing with once you have seen it.

photoHFM disease is a viral illness which typically occurs in younger children, although I occasionally see a miserable teenager who has classic Coxsackie virus findings.  In most cases the rash is preceded by a few days of fever and malaise and then the viral papules appear on the hands and soles of the feet. At the same time those papules and vesicles are often in the child’s throat, so you may see a toddler who is drooling more as it hurts to even swallow their spit!

Most kids with HFM don’t feel well and are irritable and fussy.  Occasionally you will see a child who appears totally happy, never had a fever and only has the classic Coxsackie rash on the hands, feet. The rash often occurs on the buttocks as well and may be equally as uncomfortable for those in diapers.

Because HFM is a viral illness there is no “treatment” per se.  This is where the TLC becomes important. You can use acetaminophen or ibuprofen for the fever or even for the throat discomfort. I am also a fan of things like popsicles, pudding, ice cream and Slurpees to help with the throat pain. Just make sure your child stays hydrated during the illness, they will eat their meals once they are feeling better.

HFMThe virus is contracted from person to person as well as from contaminated surfaces. This means that it is not uncommon to see “outbreaks” in daycare and preschools as the toddler set shares their germs better than their toys. The incubation period after exposure is about 3–7 days.

Once your child is fever free for 24 hours they may return to school as the rash may last anywhere from 5 – 7 days. Best prevention is still good hand washing.

Thanks to all of my little patients who were so helpful in letting me take pictures of their rash! I am getting better with the iPhone camera all of the time.

That’s your daily dose for today.  We’ll chat again tomorrow.

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