Photo Rounds Friday Archive

Rash on hands, feet, and mouth

Post Date: 10/02/2009

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A mother sought treatment for her 4-year-old son at a free clinic for homeless families. Her son had a low-grade fever and lesions on his hands and feet. The mother indicated that 2 other children in the transitional living center where they were staying had a similar rash. Upon further investigation, the physician noted mouth lesions, as well.

What's your diagnosis?

The physician diagnosed hand, foot, and mouth disease, which is most commonly caused by members of the enterovirus genus, especially coxsackieviruses. Epidemic infections are usually caused by coxsackievirus A16 or enterovirus 71. Coxsackievirus infections are highly contagious. Transmission occurs via contact with nasal and/or oral secretions, or fecal material. (Contact with nasal and oral secretions can also occur via aerosolized droplets.) During epidemics, the virus is spread from child to child and from mother to fetus. The peak incidence is in late summer and early fall.

Hand, foot, and mouth disease generally has a mild course, but it may be more severe in infants and young children. In this case, the physician reassured the mother that it would go away on its own. Treatment includes fluids and antipyretics, as needed. The following week at the free clinic, the patient was 100% better.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Hand, foot and mouth disease. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:510-511.

To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
* http://www.mhprofessional.com/product.php?isbn=0071474641