Hand, foot and mouth disease

and Carola Felchner, science journalist

Dr. med. Fabian Sinowatz is a freelancer in the medical editorial team.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Hand, foot and mouth disease is a mostly harmless but highly contagious viral disease. Children are particularly affected. The disease is spread through body fluids, stool, or contaminated objects. Typical symptoms are painful blisters on the hands, feet and around the mouth. The hand, foot and mouth disease usually heals within ten days at the latest without any consequences. Read everything you need to know about hand, foot and mouth disease: symptoms, cause, diagnosis, treatment and possible complications.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B08

Brief overview

What is hand, foot and mouth disease? A highly contagious viral disease that occurs mainly in (young) children and people with immunodeficiency. It is sometimes called "false mouth and mouth disease" or "hand, foot and mouth rash".
Contagion: via droplet infection or smear infection
Symptoms: At first flu-like symptoms, then red spots and blistering on hands, feet and in the mouth area. The infection is often symptom-free.
Diagnostics: The doctor often recognizes the disease from the typical symptoms and with the help of information from the anamnesis interview. In severe or unclear cases, further examinations (blood, stool) are useful.
Treatment: Relief of the discomfort with pain relieving tinctures, calf wraps to reduce fever, etc.
Prognosis: In most cases, hand, foot and mouth disease heals by itself and without complications. Complications rarely develop when the infection spreads to internal organs (e.g. meningitis = meningitis).

Hand, foot and mouth disease: contagion

The triggers of hand, foot and mouth disease (various enteroviruses) occur everywhere (ubiquitously) in the environment and are highly contagious. The disease is transmitted from person to person: This can happen directly via body fluids such as nasal and throat secretions, saliva or secretions from the typical skin vesicles. For example, infected people can distribute tiny droplets of saliva in the environment when they cough or sneeze, which can transmit the pathogen to healthy people (droplet infection). Infection is also possible when touching the secretion of the vesicles.

In addition, the hand-foot-mouth disease can be transmitted via smear infection: The virus-containing secretion droplets can contaminate objects and surfaces such as cutlery or doorknobs, which thus become a source of infection for healthy people. In addition, infected people excrete the virus in their stool. If you do not wash your hands (properly) after defecation, you can contaminate taps, doorknobs, etc. in this way.

The incubation period of hand, foot and mouth disease, i.e. the period between infection and the appearance of the first symptoms, is three to ten days on average. Sometimes the infection is noticeable beforehand (one day after infection at the earliest) or much later (up to a month afterwards).

Duration of the risk of infection

Patients are most contagious during the first week of illness. In this phase, the viruses multiply particularly strongly, so that they are also released into the environment in large numbers (secretions, stool).

However, there is still a certain risk of infection when the symptoms of the hand, foot and mouth disease (rash, etc.) have subsided: some infected people continue to excrete the pathogens in their stool for weeks. You should therefore wash your hands thoroughly after using the toilet or changing diapers!

Many infected people (especially adults) show no symptoms of the disease. But they are still contagious!

Hand, foot and mouth disease: symptoms

The term "hand-foot-mouth disease" already gives an idea of the parts of the body where the characteristic symptoms of the disease appear. Initially, however, it manifests itself in flu-like symptoms such as fever, poor performance, sore throat and body aches and loss of appetite.

About one to two days later, painful red spots develop in the mouth (tongue, gums, oral mucosa) and around the mouth (perioral), which after a short time turn into small blisters or superficial ulcers (canker sores).

Around the same time as the red spots in the mouth area or a few hours later, a rash develops on the hands and feet: It usually appears in the form of many red spots of different shapes and sizes, which usually do not itch at first. However, this can change if blisters form on the reddened areas. Typically the palms of the hands and the soles of the feet are affected by this rash. However, it can also arise there in other places (back of the hand, buttocks, genital area, knees, elbows, etc.).

For some people, their fingernails and toenails peel off around four to eight weeks after the disease has subsided.

This is how hand, foot and mouth disease works

The typical rash of hand, foot and mouth disease does not become visible for about a week - the disease begins with flu-like symptoms.

The skin vesicles in hand, foot and mouth disease secrete a secretion that contains many of the causative viruses. In this way, the sick person transfers the virus to other parts of his body, but also - by touching objects - to other people. Thorough hygiene is therefore very important during the illness!

However, sick people do not always have (such) complaints. Doctors assume that the symptoms described only occur in about 20 percent of the cases. Four out of five infected people have no symptoms. In adults in particular, the symptoms of hand, foot and mouth disease are often very minor. As a result, they often do not even notice the infection. The same goes for children over the age of ten. However, there is still a risk of contagion for others.

So if you suspect the disease in yourself, for example because you notice individual (unspecific) symptoms, you should not be in the presence of small children during the illness period.

Hand, Foot and Mouth Disease: Pregnancy & Newborns

If a pregnant woman becomes infected with hand, foot and mouth disease, there is generally no need to worry: the infection is usually very mild during pregnancy or has no symptoms at all (asymptomatic).

If the pregnant woman develops symptoms of hand, foot and mouth disease shortly before or after giving birth, she can transmit the infection to the newborn. Most babies have mild disease. The infection rarely spreads to internal organs (such as the liver, heart) and can then be very difficult. This risk is highest in newborns in the first two weeks of life.

Hand, foot and mouth disease: treatment

The hand, foot and mouth disease cannot be treated causally, which means that there are no drugs against the virus that causes it. But this is not necessary because the disease is usually harmless. Treatment is limited to relieving symptoms. For example, you can give a pain reliever and antipyretic drug, for example with the active ingredient paracetamol.

Acetylsalicylic acid (ASA) is also a popular pain reliever and fever reliever. However, it is not suitable for children: In connection with a viral infection, the drug can cause serious complications such as Reye's syndrome.

For painful blisters in the mouth, the doctor can prescribe a mild, pain-relieving tincture to dab on or to rinse. This usually contains the active ingredients chlorhexidine or lidocaine. Various herbal remedies (chamomile, lemon balm, thyme) can also provide relief from symptoms of hand, foot and mouth disease.

Despite the painful sores in the mouth, patients should drink enough. Otherwise there is a risk of dehydration, especially in children.

Antibiotics are generally not effective for viral infections as they only help against bacteria. In some cases, however, a bacterial infection (superinfection) can develop in addition to the viral hand, foot and mouth disease. Then antibiotic treatment may be necessary.

Hand, foot and mouth disease: home remedies

You can do something about the symptoms of hand, foot and mouth disease not only with conventional medical measures, but also with home remedies. Some examples of suitable home remedies:

Home remedies such as leg wraps can help if you have a fever.
The blisters in the mouth often make chewing and swallowing painful. Chilled or lukewarm food that does not have to be chewed heavily (such as yogurt, pudding, soup) and drinks such as cooled chamomile or marigold tea are recommended.
You can dab the painful blisters in your mouth with a cotton swab dipped in honey. This can have a soothing effect.

Hand-foot-mouth disease: homeopathy

Some people also try to support the healing process of hand, foot and mouth disease with homeopathy. So should for example Rhus toxicodendron help against the vesicular rash. Generally with febrile infections are about Apis and Belladonna recommended. An experienced doctor or homeopath can advise you on the selection, use, and dosage of homeopathic remedies for hand, foot and mouth disease.

The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

Hand, foot and mouth disease is never really calm: it can occur all year round, with a focus on late summer and autumn. In addition, the responsible pathogens are widespread everywhere. These are various enteroviruses, above all Coxsackie A viruses and the enterovirus A71.

Hand, foot and mouth disease is particularly common in children under the age of ten. However, adults can also be affected. Especially when someone falls ill in daycare, kindergarten or school, it usually doesn't take long for the highly contagious disease to spread.

People with a weak immune system are also particularly at risk. The cause of this immune deficiency can be another disease (such as HIV) or an immune-weakening therapy (e.g. taking immunosuppressants). Due to the weak immune system, the pathogens causing hand, foot and mouth disease can, in the worst case, cause meningitis or damage organs such as the liver and heart.

Hand, foot and mouth disease is often mistakenly referred to as foot and mouth disease. However, this disease only occurs in cattle, sheep and pigs and is not related to hand, foot and mouth disease. Nevertheless, the latter is often also called "false foot and mouth disease".

Hand, foot, and mouth disease: examinations & diagnosis

If you suspect hand, foot and mouth disease in yourself or your child, your family doctor or pediatrician is the right person to talk to. He will first collect all relevant information about the medical history (anamnesis) in a conversation with you. Possible questions from the doctor are:

What symptoms do you experience (fever, sore throat, loss of appetite, rash, etc.)?
Did you or your child have contact with other children with hand, foot and mouth disease (kindergarten, day nursery, etc.)?
Do you or does your child take medication?
What diseases are you or your child vaccinated against? Do you have the vaccination certificate with you?

The background to the last question is that rashes also occur in other typical “teething problems”. If you have been vaccinated against it, the doctor can rule out such diseases as the cause of the symptoms with a high degree of certainty.

The anamnesis will be followed by a physical examination. Among other things, the doctor looks at where a rash has formed and what it looks like.

The hand, foot and mouth disease can usually be clearly diagnosed on the basis of the information from the anamnesis interview and the physical examination. Further examinations are usually only necessary if the clinical picture is very severe or the symptoms cannot be clearly assigned to the hand, foot and mouth disease. The doctor can then have a blood or stool sample from the patient examined more closely for further clarification. More rarely, he takes a sample of the nerve water (liquor puncture) and sends it to the laboratory for analysis.

There are a few diseases that can cause symptoms in the mouth area similar to hand, foot and mouth disease. These include tonsillitis, glandular fever and herpes.

Hand, foot and mouth disease: course & prognosis

The hand, foot and mouth disease usually goes away on its own after seven to ten days without complications. Complications can develop in newborns, infants, and people with weakened immune systems as the virus spreads around the body. Possible consequences are, for example, meningitis or damage to the heart or liver.

Sick children should not visit community facilities (day care center, school, etc.) until the symptoms have completely subsided. The same applies to siblings if they also show possible signs of hand, foot and mouth disease.

Anyone who has ever had the disease is immune to the specific virus type that causes it. However, if you become infected with hand, foot and mouth disease through another type of virus, another disease is possible.

Hand, foot and mouth disease: prevention

There is no vaccination against hand, foot and mouth disease in this country.In order to prevent infection or transmission of the pathogen, one should pay attention to an extremely thorough hygiene. First and foremost, this includes washing your hands regularly with soap. This is especially true after sneezing or coughing, after using the toilet, after changing diapers and before and after preparing food.

When a family member becomes ill, potentially contaminated objects and surfaces such as doorknobs and toilets should be cleaned carefully. Close contact with the patient (hugging, kissing, etc.) should be avoided as far as possible. This helps prevent hand, foot and mouth infection.