The order of rash development in hand, foot, and mouth disease.

Written by Zhang Cui Xiang
Pediatrics
Updated on June 28, 2025
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At the initial stage of hand, foot, and mouth disease, children may experience symptoms such as fever, coughing, runny nose, and drooling, which are similar to those of an upper respiratory infection. Some children may also experience nausea and vomiting. Subsequently, oval or spindle-shaped blisters appear on the hands, feet, and even the back. These blisters are surrounded by a red halo, and the fluid inside the blisters is clear. The long axis of the blister aligns with the skin lines. Then, the centers of the blisters turn yellow, become concave, dry out, and begin to peel. Additionally, there are scattered, fairly hard, pale red papules or vesicles at the fingertips, and similar lesions can also appear in the mouth, such as on the lips, tongue, oral mucosa, and gums. However, the oral blisters quickly rupture, forming gray-white spots or a gray-white film surrounded by a red halo. Underneath the gray-white film, punctate or patchy erosive surfaces can be seen. These symptoms are generally quite obvious, and it is recommended to seek medical treatment promptly if observed.

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Symptoms of hand, foot, and mouth disease

Hand, foot, and mouth disease is a common infectious disease during childhood, characterized by rashes on the hands, feet, and around the mouth as described by its clinical symptoms. Concurrently, with the red rashes, there are symptoms such as fever. In children, vesicles in the throat can cause severe sore throat. These are the common symptoms of hand, foot, and mouth disease. Since hand, foot, and mouth disease is caused by a viral infection, some children may experience myocarditis-like symptoms such as chest tightness, fatigue, and shortness of breath due to the virus affecting the myocardium, or present symptoms of myocardial damage. These are common clinical symptoms of hand, foot, and mouth disease.

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How to disinfect hand, foot, and mouth disease?

Hand, foot, and mouth disease is an acute infectious disease caused by a viral infection. It mainly spreads through the respiratory tract, digestive tract, and close contact. Being in contact with a carrier or a child with the disease can result in transmission. It is important to properly handle the infected child's feces and other excretions. Clothes can be soaked in a 3% bleach solution and exposed to sunlight. Keep the room well-ventilated. Other contaminated daily items, such as toys or closely contacted objects like dishware and children's eating utensils, should be disinfected promptly.

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Symptoms of hand, foot, and mouth disease

Hand, foot, and mouth disease is caused by an intestinal virus infection. It primarily manifests as a disseminated rash of maculopapules or vesicular papules on the hands, feet, mouth, and buttocks. The main symptoms of hand, foot, and mouth disease start with a fever in children, accompanied by a sore throat, reluctance to eat, and some children may have mild cough and runny nose. During a physical examination, small vesicles can be found on the oral mucosa, or they may have already ulcerated into shallow ulcers. Subsequently, rashes appear on the hands and feet, starting as maculopapules and slowly transforming into vesicular papules, about 3 to 7mm in size, with a firm base. The skin of the vesicle is slightly thicker, surrounded by erythema, and the rash is mostly located at the extremities. Sometimes, it can extend to the arms, legs, buttocks, and perineum, showing a centrifugal distribution. The number of rashes is relatively small, typically ranging from a few to several dozen. Most of them resolve on their own in 2 to 3 days without scaling, scarring, or pigmentation. Vesicles or ulcers in the mouth mostly heal within a week. Most cases of hand, foot, and mouth disease have a short duration and mild condition, with generally good prognosis.

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What should I do about hand, foot, and mouth disease?

Hand, foot, and mouth disease is a common exanthematous infectious disease in children caused by enterovirus infections. Most cases are mild to moderate and can be treated at home with oral medication. Doctors generally prescribe antiviral medications, and if the child's temperature exceeds 38.5 degrees Celsius, antipyretic medications are also required. If there is discomfort in the throat, some medications can be sprayed to relieve local discomfort. For severe cases, such as those caused by EV71 virus infection, it is crucial to be vigilant. This type of infection can lead to symptoms involving the nervous system and may rapidly progress to severe conditions. Therefore, if it is confirmed that the hand, foot, and mouth disease is caused by EV71 infection and the child's condition is serious, hospitalization should be promptly sought. Additionally, for children under three years old, it's important to actively vaccinate against hand, foot, and mouth disease to prevent illness caused by EV71 virus infection.

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Does hand, foot and mouth disease itch?

Hand, foot, and mouth disease is a condition caused by an intestinal virus, primarily characterized by herpes on the hands, feet, oral cavity, and buttocks. Some affected individuals may experience fever, ranging from low to moderate, while others may have high fever, and still others may not have any fever at all. The herpes is neither painful nor itchy, so there is no need for special treatment or handling of the herpes, just symptomatic treatment and timely fever reduction when necessary. For common cases, it is appropriate to orally administer some antiviral medications, and at the same time, take some traditional Chinese medicine that clears heat and detoxifies, while maintaining clean and hygienic skin.