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.1 While it predominantly affects children, it is important to note that it can also affect adults. Although it is not a life threatening infection, it can cause a painful rash and is highly contagious. The infection is easily spread in multiple ways, including via respiratory droplets, contact with vesicular or nasal secretions, or through fecal-oral transmission. Most cases occur during the summer and fall seasons but individuals can be infected at any time of the year.
HFMD typically starts with a few days of non-specific viral symptoms, such as fever, cough, sore throat, and fatigue. It is then followed by an eruption of intraoral macules and vesicles and a widespread distribution of oval shaped macules that predominantly involve the hands and feet.1 Both children and adults can present atypically. Atypical presentations include vesicles and bullae on extensor surfaces such as the forearms, as well as eruptions on the face or buttocks.2 Other atypical morphologies include eczema herpeticum-like, Gianotti-Crosti-like, and purpuric/petechiae.3 Atypical hand, food, and mouth disease cases are often caused by coxsackievirus A6, however other strains of coxsackievirus can also cause atypical symptoms.2,3
Our 35-year-old female patient presented with eroded papules and vesicles around the mouth. A diagnosis of atypical HFMD was made clinically in the following days when the patient developed the more classic intraoral and acral macules and vesicles.
Similar to our case, HFMD is most often diagnosed clinically. PCR testing from an active vesicle or nasopharyngeal swab can be obtained. Treatment for HFMD is supportive and symptoms generally resolve over 7-10 days. Over-the-counter analgesics, such as ibuprofen and acetaminophen, as well as oral analgesics that contain lidocaine or diphenhydramine are often helpful3. In this case, our patient improved over the course of seven days without needing therapy.
This case and the photos were submitted by Vanessa Ortega, BS, University of California, San Diego; Brooke Resh Sateesh, MD, and Justin Gordon, MD, San Diego Family Dermatology. The column was edited by Donna Bilu Martin, MD.
Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at mdedge.com/dermatology. To submit a case for possible publication, send an email to dermnews@mdedge.com.
References
1. Centers for Disease Control and Prevention. (2023, June 20). Symptoms of hand, foot, and mouth disease.
2. Drago F et al. J Am Acad Dermatol. 2017 Aug;77(2):e51-6. doi: 10.1016/j.jaad.2017.03.046.
3. Starkey SY et al. Pediatr Dermatol. 2024 Jan-Feb;41(1):23-7. doi: 10.1111/pde.15461.
.1 While it predominantly affects children, it is important to note that it can also affect adults. Although it is not a life threatening infection, it can cause a painful rash and is highly contagious. The infection is easily spread in multiple ways, including via respiratory droplets, contact with vesicular or nasal secretions, or through fecal-oral transmission. Most cases occur during the summer and fall seasons but individuals can be infected at any time of the year.
HFMD typically starts with a few days of non-specific viral symptoms, such as fever, cough, sore throat, and fatigue. It is then followed by an eruption of intraoral macules and vesicles and a widespread distribution of oval shaped macules that predominantly involve the hands and feet.1 Both children and adults can present atypically. Atypical presentations include vesicles and bullae on extensor surfaces such as the forearms, as well as eruptions on the face or buttocks.2 Other atypical morphologies include eczema herpeticum-like, Gianotti-Crosti-like, and purpuric/petechiae.3 Atypical hand, food, and mouth disease cases are often caused by coxsackievirus A6, however other strains of coxsackievirus can also cause atypical symptoms.2,3
Our 35-year-old female patient presented with eroded papules and vesicles around the mouth. A diagnosis of atypical HFMD was made clinically in the following days when the patient developed the more classic intraoral and acral macules and vesicles.
Similar to our case, HFMD is most often diagnosed clinically. PCR testing from an active vesicle or nasopharyngeal swab can be obtained. Treatment for HFMD is supportive and symptoms generally resolve over 7-10 days. Over-the-counter analgesics, such as ibuprofen and acetaminophen, as well as oral analgesics that contain lidocaine or diphenhydramine are often helpful3. In this case, our patient improved over the course of seven days without needing therapy.
This case and the photos were submitted by Vanessa Ortega, BS, University of California, San Diego; Brooke Resh Sateesh, MD, and Justin Gordon, MD, San Diego Family Dermatology. The column was edited by Donna Bilu Martin, MD.
Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at mdedge.com/dermatology. To submit a case for possible publication, send an email to dermnews@mdedge.com.
References
1. Centers for Disease Control and Prevention. (2023, June 20). Symptoms of hand, foot, and mouth disease.
2. Drago F et al. J Am Acad Dermatol. 2017 Aug;77(2):e51-6. doi: 10.1016/j.jaad.2017.03.046.
3. Starkey SY et al. Pediatr Dermatol. 2024 Jan-Feb;41(1):23-7. doi: 10.1111/pde.15461.
.1 While it predominantly affects children, it is important to note that it can also affect adults. Although it is not a life threatening infection, it can cause a painful rash and is highly contagious. The infection is easily spread in multiple ways, including via respiratory droplets, contact with vesicular or nasal secretions, or through fecal-oral transmission. Most cases occur during the summer and fall seasons but individuals can be infected at any time of the year.
HFMD typically starts with a few days of non-specific viral symptoms, such as fever, cough, sore throat, and fatigue. It is then followed by an eruption of intraoral macules and vesicles and a widespread distribution of oval shaped macules that predominantly involve the hands and feet.1 Both children and adults can present atypically. Atypical presentations include vesicles and bullae on extensor surfaces such as the forearms, as well as eruptions on the face or buttocks.2 Other atypical morphologies include eczema herpeticum-like, Gianotti-Crosti-like, and purpuric/petechiae.3 Atypical hand, food, and mouth disease cases are often caused by coxsackievirus A6, however other strains of coxsackievirus can also cause atypical symptoms.2,3
Our 35-year-old female patient presented with eroded papules and vesicles around the mouth. A diagnosis of atypical HFMD was made clinically in the following days when the patient developed the more classic intraoral and acral macules and vesicles.
Similar to our case, HFMD is most often diagnosed clinically. PCR testing from an active vesicle or nasopharyngeal swab can be obtained. Treatment for HFMD is supportive and symptoms generally resolve over 7-10 days. Over-the-counter analgesics, such as ibuprofen and acetaminophen, as well as oral analgesics that contain lidocaine or diphenhydramine are often helpful3. In this case, our patient improved over the course of seven days without needing therapy.
This case and the photos were submitted by Vanessa Ortega, BS, University of California, San Diego; Brooke Resh Sateesh, MD, and Justin Gordon, MD, San Diego Family Dermatology. The column was edited by Donna Bilu Martin, MD.
Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at mdedge.com/dermatology. To submit a case for possible publication, send an email to dermnews@mdedge.com.
References
1. Centers for Disease Control and Prevention. (2023, June 20). Symptoms of hand, foot, and mouth disease.
2. Drago F et al. J Am Acad Dermatol. 2017 Aug;77(2):e51-6. doi: 10.1016/j.jaad.2017.03.046.
3. Starkey SY et al. Pediatr Dermatol. 2024 Jan-Feb;41(1):23-7. doi: 10.1111/pde.15461.
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<root generator="drupal.xsl" gversion="1.7"> <header> <fileName>167295</fileName> <TBEID>0C04F055.SIG</TBEID> <TBUniqueIdentifier>MD_0C04F055</TBUniqueIdentifier> <newsOrJournal>News</newsOrJournal> <publisherName>Frontline Medical Communications</publisherName> <storyname>April Make the Dx</storyname> <articleType>353</articleType> <TBLocation>QC Done-All Pubs</TBLocation> <QCDate>20240314T152838</QCDate> <firstPublished>20240314T153956</firstPublished> <LastPublished>20240314T153957</LastPublished> <pubStatus qcode="stat:"/> <embargoDate/> <killDate/> <CMSDate>20240314T153956</CMSDate> <articleSource/> <facebookInfo/> <meetingNumber/> <byline>Donna Bilu Martin</byline> <bylineText>VANESSA ORTEGA, BS, BROOKE RESH SATEESH, MD, AND JUSTIN GORDON, MD</bylineText> <bylineFull>VANESSA ORTEGA, BS, BROOKE RESH SATEESH, MD, AND JUSTIN GORDON, MD</bylineFull> <bylineTitleText/> <USOrGlobal/> <wireDocType/> <newsDocType>Column</newsDocType> <journalDocType/> <linkLabel/> <pageRange/> <citation/> <quizID/> <indexIssueDate/> <itemClass qcode="ninat:text"/> <provider qcode="provider:imng"> <name>IMNG Medical Media</name> <rightsInfo> <copyrightHolder> <name>Frontline Medical News</name> </copyrightHolder> <copyrightNotice>Copyright (c) 2015 Frontline Medical News, a Frontline Medical Communications Inc. company. All rights reserved. This material may not be published, broadcast, copied, or otherwise reproduced or distributed without the prior written permission of Frontline Medical Communications Inc.</copyrightNotice> </rightsInfo> </provider> <abstract/> <metaDescription>Hand, foot, and mouth disease (HFMD) is a viral infection that commonly affects children under the age of five. It is primarily caused by coxsackieviruses and o</metaDescription> <articlePDF/> <teaserImage>300782</teaserImage> <title>Atypical Hand, Foot, and Mouth Disease</title> <deck/> <disclaimer/> <AuthorList/> <articleURL/> <doi/> <pubMedID/> <publishXMLStatus/> <publishXMLVersion>1</publishXMLVersion> <useEISSN>0</useEISSN> <urgency/> <pubPubdateYear/> <pubPubdateMonth/> <pubPubdateDay/> <pubVolume/> <pubNumber/> <wireChannels/> <primaryCMSID/> <CMSIDs/> <keywords/> <seeAlsos/> <publications_g> <publicationData> <publicationCode>skin</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>im</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>fp</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> </publications_g> <publications> <term canonical="true">13</term> <term>21</term> <term>15</term> </publications> <sections> <term>52</term> <term canonical="true">87</term> </sections> <topics> <term>271</term> <term canonical="true">234</term> <term>203</term> <term>176</term> </topics> <links> <link> <itemClass qcode="ninat:picture"/> <altRep contenttype="image/jpeg">images/24012746.jpg</altRep> <description role="drol:caption"/> <description role="drol:credit">Vanessa Ortega, Dr. Brooke Resh Sateesh, and Dr. Justin Gordon</description> </link> <link> <itemClass qcode="ninat:picture"/> <altRep contenttype="image/jpeg">images/24012747.jpg</altRep> <description role="drol:caption"/> <description role="drol:credit">Vanessa Ortega, Dr. Brooke Resh Sateesh, and Dr. Justin Gordon</description> </link> <link> <itemClass qcode="ninat:picture"/> <altRep contenttype="image/jpeg">images/2400f1a6.jpg</altRep> <description role="drol:caption">Dr. Donna Bilu Martin</description> <description role="drol:credit"/> </link> </links> </header> <itemSet> <newsItem> <itemMeta> <itemRole>Main</itemRole> <itemClass>text</itemClass> <title>Atypical Hand, Foot, and Mouth Disease</title> <deck/> </itemMeta> <itemContent> <p><span class="tag metaDescription">Hand, foot, and mouth disease (HFMD) is a viral infection that commonly affects children under the age of five. It is primarily caused by coxsackieviruses and other enterovirus species</span>.<sup>1</sup> While it predominantly affects children, it is important to note that it can also affect adults. Although it is not a life threatening infection, it can cause a painful rash and is highly contagious. The infection is easily spread in multiple ways, including via respiratory droplets, contact with vesicular or nasal secretions, or through fecal-oral transmission. Most cases occur during the summer and fall seasons but individuals can be infected at any time of the year. [[{"fid":"300782","view_mode":"medstat_image_flush_right","fields":{"format":"medstat_image_flush_right","field_file_image_alt_text[und][0][value]":"","field_file_image_credit[und][0][value]":"Vanessa Ortega, Dr. Brooke Resh Sateesh, and Dr. Justin Gordon","field_file_image_caption[und][0][value]":""},"type":"media","attributes":{"class":"media-element file-medstat_image_flush_right"}}]]</p> <p>HFMD typically starts with a few days of non-specific viral symptoms, such as fever, cough, sore throat, and fatigue. It is then followed by an eruption of intraoral macules and vesicles and a widespread distribution of oval shaped macules that predominantly involve the hands and feet.<sup>1</sup> Both children and adults can present atypically. Atypical presentations include vesicles and bullae on extensor surfaces such as the forearms, as well as eruptions on the face or buttocks.<sup>2</sup> Other atypical morphologies include eczema herpeticum-like, Gianotti-Crosti-like, and purpuric/petechiae.<sup>3</sup> Atypical hand, food, and mouth disease cases are often caused by coxsackievirus A6, however other strains of coxsackievirus can also cause atypical symptoms.<sup>2,3</sup> <br/><br/>Our 35-year-old female patient presented with eroded papules and vesicles around the mouth. A diagnosis of atypical HFMD was made clinically in the following days when the patient developed the more classic intraoral and acral macules and vesicles.[[{"fid":"300783","view_mode":"medstat_image_flush_right","fields":{"format":"medstat_image_flush_right","field_file_image_alt_text[und][0][value]":"","field_file_image_credit[und][0][value]":"Vanessa Ortega, Dr. Brooke Resh Sateesh, and Dr. Justin Gordon","field_file_image_caption[und][0][value]":""},"type":"media","attributes":{"class":"media-element file-medstat_image_flush_right"}}]] <br/><br/>Similar to our case, HFMD is most often diagnosed clinically. PCR testing from an active vesicle or nasopharyngeal swab can be obtained. Treatment for HFMD is supportive and symptoms generally resolve over 7-10 days. Over-the-counter analgesics, such as ibuprofen and acetaminophen, as well as oral analgesics that contain lidocaine or diphenhydramine are often helpful3. In this case, our patient improved over the course of seven days without needing therapy. [[{"fid":"271802","view_mode":"medstat_image_flush_right","fields":{"format":"medstat_image_flush_right","field_file_image_alt_text[und][0][value]":"Dr. Donna Bilu Martin, Premier Dermatology, MD, Aventura, Fla.","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][value]":"Dr. Donna Bilu Martin"},"type":"media","attributes":{"class":"media-element file-medstat_image_flush_right"}}]]<br/><br/>This case and the photos were submitted by Vanessa Ortega, BS, University of California, San Diego; Brooke Resh Sateesh, MD, and Justin Gordon, MD, San Diego Family Dermatology. The column was edited by Donna Bilu Martin, MD.<br/><br/></p> <p> <em>Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at <span class="Hyperlink"><a href="http://mdedge.com/dermatology">mdedge.com/dermatology</a></span>. To submit a case for possible publication, send an email to <span class="Hyperlink"><a href="mailto:dermnews%40mdedge.com?subject=">dermnews@mdedge.com</a></span>.</em> </p> <h2>References </h2> <p>1. <span class="Hyperlink"><a href="https://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html">Centers for Disease Control and Prevention</a></span>. (2023, June 20). Symptoms of hand, foot, and mouth disease. <br/><br/>2. Drago F et al. <span class="Hyperlink"><a href="https://www.jaad.org/article/S0190-9622(17)30437-1/fulltext">J Am Acad Dermatol. 2017 Aug;77(2):e51-6. doi: 10.1016/j.jaad.2017.03.046</a></span>.<br/><br/>3. Starkey SY et al. <span class="Hyperlink"><a href="https://onlinelibrary.wiley.com/doi/10.1111/pde.15461">Pediatr Dermatol. 2024 Jan-Feb;41(1):23-7. doi: 10.1111/pde.15461</a></span>.</p> </itemContent> </newsItem> <newsItem> <itemMeta> <itemRole>teaser</itemRole> <itemClass>text</itemClass> <title/> <deck/> </itemMeta> <itemContent> <p>On the second day, the patient developed erythematous macules on her palms and soles. </p> </itemContent> </newsItem> </itemSet></root>
