Dermatologic Manifestations of Hand-Foot-And-Mouth Disease

Introduction

Hand-foot-mouth disease, or HFMD, is a common viral infection that initially affects the throat. Hand-foot-mouth diseases are primarily observed in infants and children. Adults are rarely affected by hand, foot mouth disease. The symptoms of hand-foot-mouth disease are involved in the hands, mouth, feet, genital region, and buttocks. Coxsackie virus is the causative virus of hand-foot-mouth disease. Children between five to ten years are affected mainly by hand-foot-mouth disease. The hand-foot-mouth disease is a benign condition, and the symptoms of the hand-foot-mouth disease will be resolved independently.

What Is Hand-Foot-And-Mouth Disease?

Hand-foot-mouth disease, HFMD, is a viral infection caused by the coxsackievirus. The coxsackie belongs to the picornaviridae family, and the non-enveloped coxsackievirus is a single-stranded RNA (ribonucleic acid) virus. Hand-foot-mouth disease is a viral infectious condition characterized by exanthematous ulcers associated with macules, papules, and vesicles. The incidence of hand-foot-mouth disease is high in early autumn and summer climates. It is also observed from the epidemiological data that hand-foot-mouth disease is highly susceptible in males compared to females. The acute symptoms of hand-foot-mouth disease last 10 to 14 days and are resolved within a month.

What Are the Causes of Hand-Foot-And-Mouth Disease?

The hand-foot-mouth disease is a virus-infected exanthematous condition. The human-to-human spread of hand-foot-mouth disease occurs through tiny aerosols released from the infected person's sneezing, blowing, and coughing. The various modes of transmission of hand, foot mouth disease are mentioned below.

• Coxsackie virus A1.

• Enterovirus A71.

• Infected aerosols from a sneeze, coughing and blowing off the nose.

• Touching the virus-contaminated surfaces or objects like toys and clothes.

• Touching the expelled fluid from the blisters in the hand-foot-mouth disease.

• Spread can also happen via oral secretions like saliva from the infected host and the stools.

• The infection can spread to multiple organs and affects the central nervous system, heart, skin, and liver.

What Are the Symptoms of Hand-Foot-And-Mouth Disease?

The symptoms of hand-foot-mouth disease are primarily seen in the hand, foot, and mouth. The initial sign of the hand-foot-mouth disease is throat or oral pain, and enanthem, called the red rash, is the last symptom. The other symptoms of hand-foot-mouth disease are mentioned below.

• Throat pain.

• Skin rash.

• Skin is red and called erythematous, and the vesicles are present.

• A thin halo surrounds the vesicles.

• Skin ulcers result in vesicle rupture.

• Ulcers have a gray-yellow base, and the surrounding area is erythematous.

• Macules and bumps are seen in the exanthematous areas.

• Pain and pruritus are absent in hand-foot-mouth disease.

• The feet, buttocks, legs, arms, and dorsal aspects are exanthematous.

• Aseptic meningitis.

• Low-grade fever.

• Loss of appetite.

• General malaise.

• Encephalitis.

• Polio-like syndrome.

• Acute transverse myelitis.

• Guillain- Barre syndrome.

• Benign intracranial hypertension.

• Acute cerebellar ataxia.

What Is the Diagnosis of Hand-Foot-And-Mouth Disease?

The diagnosis is based on the clinical examination of symptoms. The virus is present in the stool of the infected patients. The biopsy is taken and examined to differentiate the hand-foot-mouth disease from the varicella zoster infection. The various diagnostic tools for diagnosing hand-foot-mouth disease are mentioned below.

• History of transmission.

• Physical examination. Symptoms in the hand, foot, and mouth are examined.

• Skin biopsy.

• Light microscopy.

• Serology, the IgG levels are monitored during the recovery period.

• PCR assay, the polymerase chain reaction is done. The polymerase chain reaction is the confirmed diagnosis of hand-foot-mouth disease.

• Imaging techniques.

What Are the Differential Diagnoses of Hand-Foot-And-Mouth Disease?

Some symptoms of hand-foot-mouth disease are common in other skin conditions. Biopsy differentiates hand-foot-mouth disease from other viral infections like varicella-zoster and herpes. Some other differential diagnoses of hand-foot-mouth disease are mentioned below.

• Varicella zoster virus.

• Herpes zoster infection.

• Herpes simplex infection.

• Herpangina.

• Erythema multiforme.

• Enterovirus.

• Kawasaki disease.

• Toxic epidermal necrolysis, TEN.

• Viral pharyngitis.

What Are the Complications of Hand Foot Mouth Disease?

In severe cases, hand-foot-mouth disease leads to complications. The symptoms of hand-foot-mouth disease last for 10 to 14 days and are resolved within a month. However, in severe recurrence and remission cases, complications are involved. Some intricacies of hand-foot-mouth disease are given below.

• Persistent stomatitis.

• Aseptic meningitis.

• Interstitial pneumonia.

• Myocarditis.

• Pulmonary edema.

• Spontaneous abortions.

How to Prevent Hand-Foot-Mouth Disease?

Hand-foot-mouth diseases are viral infections that need to be prevented. Certain precautions can prevent the transmission of the virus. Some of the preventive measures for hand-foot-mouth disease are given below.

• Regular hand washing is done.

• Wear masks and gloves in treating infected patients.

• Avoid bursting or scratching the affected area.

• Good oral hygiene is maintained.

• Always stay hydrated by drinking plenty of water.

• Good personal hygiene is followed.

• Visit the doctor in case of an emergency.

What Is the Treatment of Hand Foot Mouth Disease?

Hand-foot-mouth disease is a benign condition, and the acute symptoms will be resolved on their own within 7 to 20 days. Therefore, supportive treatment is primarily given to treat hand-foot-mouth disease. In addition, the researchers developed a specific treatment to manage the neurological complications of hand-foot-mouth disease. The other treatment modes for hand-foot-mouth disease are given below.

• Non-steroidal anti-inflammatory drugs, NSAIDs, and Acetaminophen are given to control fever and pain.

• Body hydration is maintained.

• Gargling is done with liquid Ibuprofen and Diphenhydramine to alleviate the painful ulcer.

• In severe cases of hand, foot, and mouth disease, Ribavirin, Quinacrine, and Amantadine are administered.

• Other novel agents include molecular decoys, receptor antagonists, translation, and replication inhibitors.

Conclusion

Hand-foot-mouth disease is a common viral infection caused by the coxsackie virus, most commonly observed in infants and children within ten years. The initial symptoms of hand-foot-mouth disease are throat or oral pain, and the secondary symptoms are skin rash. After that, skin symptoms like cysts, bumps, and ulcers are seen, and they last for 7 to 21 days and are resolved in a month. The diagnosis is confirmed with the polymerase chain reaction, and the treatment is done according to the severity of the conditions. Milder symptoms are resolved independently, and severe conditions need immediate hospitalization. Preventive measures are followed to avoid spreading infection and stay hydrated to prevent the risk of hand-foot-mouth disease. However, the prognosis of hand-foot-mouth disease is good.