Hand, Foot, and Mouth Disease (HFMD) is a common viral illness, mild, that affects young children. Its symptoms can sometimes resemble those of other conditions. This article clarifies common illnesses that might be mistaken for HFMD and when to seek professional medical advice.
Understanding Hand, Foot, and Mouth Disease
Hand, Foot, and Mouth Disease is caused by viruses belonging to the enterovirus family, Coxsackievirus A16. The infection spreads through close personal contact, including respiratory droplets from coughing or sneezing, contact with nasal secretions, saliva, fluid from blisters, or stool of an infected person. Individuals are most contagious during the first week of illness.
Symptoms begin with a fever, sore throat, and a reduced appetite. One or two days later, painful sores develop in the mouth, on the tongue, gums, and inside the cheeks. A non-itchy skin rash then appears, as red spots and blisters on the palms of the hands, soles of the feet, and occasionally on the buttocks. HFMD is a mild illness that resolves within 7 to 10 days.
Conditions That Appear Similar
Several other conditions mimic Hand, Foot, and Mouth Disease, making identification challenging without medical expertise. Herpes simplex virus, specifically herpetic gingivostomatitis, causes painful mouth sores, fever, and swollen gums. These oral lesions are uncomfortable, leading to difficulty with eating and drinking.
Chickenpox, caused by the varicella-zoster virus, is a common childhood illness known for its rash. This rash starts as itchy spots that become fluid-filled blisters, appearing first on the trunk before spreading across the body. Accompanying symptoms include fever and general fatigue.
Aphthous ulcers, commonly known as canker sores, are painful sores developing inside the mouth. Unlike HFMD, these ulcers are isolated, do not spread to the hands or feet, and are not associated with a widespread rash or fever. Scabies manifests as an itchy rash that worsens at night. The rash appears as tiny red bumps or burrows, found in skin folds or between fingers.
Impetigo is a bacterial skin infection with red sores that rupture, ooze fluid, and then form a yellowish-brown crust. This rash appears around the nose and mouth, or on the arms and legs. Allergic reactions or contact dermatitis cause skin changes, with a localized itchy rash with redness, bumps, or blisters. This occurs after direct contact with an allergen or irritant.
Key Differences to Observe
Distinguishing Hand, Foot, and Mouth Disease from these look-alike conditions depends on characteristics of the rash and associated symptoms. The rash in HFMD appears on the palms of the hands, soles of the feet, inside the mouth, and sometimes on the buttocks. In contrast, chickenpox lesions are more widespread, starting on the trunk and spreading outwards, with new lesions appearing in “crops” at different stages of development. Scabies, on the other hand, affects skin folds, between fingers, and wrists, though in infants and the elderly, it can appear on the palms and soles.
The appearance of the lesions provides clues. HFMD blisters are small, oval, and are not itchy. Chickenpox blisters, however, are itchy and evolve from red bumps to fluid-filled vesicles that eventually crust over. Impetigo sores are with their rapid rupture, oozing, and the formation of a honey-colored crust. Scabies presents with tiny, raised burrows or lines on the skin, a feature absent in HFMD.
Associated symptoms aid in differentiation. Herpetic gingivostomatitis involves severe pain and inflammation within the mouth and gums, leading to difficulty eating and drinking, more pronounced than the oral discomfort of HFMD. While HFMD causes mouth sores, the severe gingival inflammation seen in herpetic gingivostomatitis is distinct.
Unlike the itching of chickenpox and scabies, the HFMD rash is non-itchy or only mildly uncomfortable. Aphthous ulcers are isolated to the mouth and lack the systemic symptoms like fever and widespread rash associated with HFMD. Contact dermatitis is localized in nature and has a correlation with exposure to an irritant or allergen, without the systemic viral symptoms of HFMD.
When to Consult a Doctor
Seeking professional medical evaluation is advised if there is uncertainty about a diagnosis or symptoms. A doctor provides an accurate diagnosis and recommends care. Immediate medical attention is warranted for a high or prolonged fever that does not respond to fever-reducing medication.
Signs of dehydration, such as decreased urination, dry mouth, reduced tears, or unusual lethargy, require prompt medical assessment, especially if mouth pain prevents adequate fluid intake. Severe pain, particularly mouth pain that significantly interferes with eating or drinking, also warrants a doctor’s visit.
Medical consultation is recommended if symptoms worsen, do not improve within 7 to 10 days, or if new symptoms appear. Neurological changes, such as unusual drowsiness, confusion, a stiff neck, severe headache, or seizures, require immediate medical attention. If the rash spreads rapidly, becomes very painful, or shows signs of a bacterial infection like pus or increasing redness, seek medical advice.