++
Hand, foot, and mouth syndrome (HFMS) is a seasonal (summer-fall) viral infection caused most frequently by coxsackievirus A16, with other enterovirus serotypes implicated less frequently. Toddlers and school-aged children are affected most commonly, although adults may also be affected. It is characterized by a prodrome of fever, malaise, sore throat, and anorexia over 1 to 2 days, followed by the appearance of the characteristic enanthem in the posterior oropharynx and tonsillar pillars consisting of small, red macules evolving into small vesicles 1 to 3 mm in diameter that rapidly ulcerate. Oral manifestations are followed by a vesicular eruption characterized by 3- to 7-mm erythematous macules with a central gray vesicle on the hands and feet involving the palmar and plantar surfaces and interdigital surfaces. A nonvesicular rash may also be present on the buttocks, face, and legs.
++++++++
+++
Management and Disposition
++
Supportive therapy (hydration maintenance with fever and pain control) is the mainstay of treatment. It is essential to discuss the duration and characteristics of the illness with the parents. In most cases, the course is self-limited, resolving in 2 to 3 days after the appearance of rash without further complication. Rare secondary complications such as myocarditis, pneumonia, pulmonary hemorrhage, and meningoencephalitis may occur.
++++
++
The child is contagious until all vesicles have resolved.
The oral lesions tend to involve the posterior oropharynx, as contrasted with those of herpetic gingivostomatitis, which typically involve the anterior structures ...