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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2011  |  Volume : 29  |  Issue : 2  |  Page : 165-167

Hand, foot and mouth disease

Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental College and Hospital, Kamalanagar, Dilsukhnagar, Hyderabad, Andhra Pradesh, India

Date of Web Publication9-Sep-2011

Correspondence Address:
Radhika Muppa
Panineeya Mahavidyalaya Institute of Dental College and Hospital, Kamalanagar, Dilsukhnagar, Hyderabad - 500 060, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.84692

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Hand, foot and mouth disease (HFMD) is an acute viral illness with a distinct clinical presentation of oral and characteristic distal extremity lesions. Knowledge of this is important for the dentists as the oral lesions are the first clinical signs and sometimes may be the only sign because the condition occasionally may regress even before the lesions appear on the extremities. This case describes a 5-year-old boy in whom low-grade fever of 38.7°C and oral lesions were the initial manifestations. Proper diagnosis was established later based on the typical location of the initial intraoral ulcers on the soft palate followed by cutaneous lesions on the hands and feet with vesicle formation surrounded by an erythematous halo. The recognition of HFMD is important for both pediatricians and pedodontists as oral manifestations are the first signs and may mimic many other conditions like acute herpetic gingivostomstomatitis, apthous stomatitis, chickenpox, erythema multiformae and misdiagnosis may involve an inappropriate prescription of medication.

Keywords: Enterovirus, hand, foot, and mouth, HFMD, ulcer, vesicle

How to cite this article:
Muppa R, Bhupatiraju P, Duddu M, Dandempally A. Hand, foot and mouth disease. J Indian Soc Pedod Prev Dent 2011;29:165-7

How to cite this URL:
Muppa R, Bhupatiraju P, Duddu M, Dandempally A. Hand, foot and mouth disease. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2021 Oct 16];29:165-7. Available from: https://www.jisppd.com/text.asp?2011/29/2/165/84692

   Introduction Top

Hand, foot, and mouth disease (HFMD) is a highly infectious disease characterized by multiple vesicles on the hands and feet and in the oral cavity. It usually occurs in children in summer. Coxsackievirus A16 is the most common virus causing HFMD; other causative viruses include coxsackieviruses A5, A7, A9, A10, B2, B5, and enterovirus 71. [1],[2] Clinically, the onset is characterized by fever and the appearance of papules on the hands, feet, and in the oral cavity, which progress to vesicles. [1],[3] Infection generally occurs via the fecal-oral route or via contact with skin lesions and oral secretions. Viremia develops, followed by invasion of the skin and mucous membranes. Widespread apoptosis likely results in the characteristic lesion formation. Symptoms usually subside within 7-10 days. [3] Although several cases of HFMD have been reported, it has been rarely reported having both oral and cutaneous lesions simultaneously.

   Case Report Top

A 5-year-old boy previously in good health presented with a chief complaint of sore throat, malaise and anorexia. The intraoral examination revealed remarkable ulcers of 2-3 mm with an erythematous base. Ulcers were involving the posterior third of the palate, buccal mucosa and tongue [Figure 1]a, b, and [Figure 2]. The total number of ulcers were 7-12. Physical examination revealed typical cutaneous lesions involving dorsal aspects of hands and sides of the fingers on both hands and feet [Figure 3] and [Figure 4]. Each lesion was an ∼2- to 10-mm erythematous macule on which a central gray oral vesicle was seen. These lesions were asymptomatic. The diagnosis of HFMD was made based on the history as well as typical clinical findings including typical location and distribution of skin lesions.
Figure 1: (a) Ulcers on the palate with an erythematous halo. (b) Ulcers on the palate

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Figure 2: Ulcer on the labial mucosa with an erythematous halo

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Figure 3: Cutaneous lesions on the dorsal surface of the feet

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Figure 4: Typical cutaneous lesion on the palmer surface of the hand which is an elliptical vesicle surrounded by an erythematous halo. The long axis of the lesion is oriented along the skin lines

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Treatment was palliative with an analgesic for severe oral pain and topical viscous lidocain gel application. On follow-up, the whole condition regressed by 10 days without any complications.

   Discussion Top

HFMD is a human syndrome caused by intestinal viruses of the Picornaviridae family. The most common strains causing HFMD are Coxsackie A virus and enterovirus. [4] HFMD usually affects infants and children, and is quite common. The incubation period is about 3-6 days. [5] The infection is highly contagious and is spread by horizontal transmission from a child to another child and from a mother to the fetus. The spread occurs through a direct contact with mucous, oral or nasal secretions, or feces of an infected person. Initial viral implantation in the buccal and ileal mucosa is followed by lymph nodes in 24 h. [6] Viremia occurs rapidly with a spread to the oral mucosa and skin; usually by the seventh day, neutralizing antibody levels increase and the virus is eliminated. [6] The initial presentation includes erythematous papules on the palms, feet and in the oral cavity, accompanied by prodromal symptoms such as myalgia, mild fever and abdominal pain. The lesions usually evolve into vesicles and then spontaneously resolve within 1 or 2 weeks. [7] Lesions are usually asymptomatic, but in some cases, pressure and touch can provoke pain. In addition, oral lesions may occur without cutaneous lesions, [8] and HFMD without oral mucosal lesions has also been reported in an immunocompromised adult. [9] HFMD usually occurs in the summer, from June to October, although it has been also reported in the winter. [9] The coxsackievirus belongs to the Picornaviridae family (small RNA viruses) together with echovirus, enterovirus, and poliovirus. Humans are thought to be the only natural host of the coxsackievirus.

Treatment is symptomatic, and the disease resolves spontaneously without complications within 7-10 days. However, there have been rare reports of severe complications such as pneumonia, cardiomyositis, and aseptic meningitis. [10],[11] Low-level laser therapy has been shown to reduce or shorten the duration of oral ulcers but it was not necessary in this case. [12]

   Conclusions Top

In conclusion, pedodontists have an edge over others in diagnosing the condition more accurately as oral ulcerations may represent as the first sign of the disease and an early identification will prevent the infection from spreading to the children and vulnerable adults. Moreover, pedodontists have a key role in educating the patients on good oral hygiene and avoidance of rupture of the blisters.

   References Top

1.Shin JU, Oh SH, Lee JH. A Case of Hand-foot-mouth Disease in an Immunocompetent Adult. Ann Dermatol 2010;22:216-8.  Back to cited text no. 1
2.Robinson CR, Doane FW, Rhodes AJ. Report of an outbreak of febrile illness with pharyngeal lesions and exanthema: Toronto, summer 1957; Isolation of group A Coxsackie virus. Can Med Assoc J 1958;79:615-21.   Back to cited text no. 2
3.Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick′s dermatology in general medicine. 7th ed. New York: McGraw-Hill; 2008. p. 1867-9.  Back to cited text no. 3
4.Suhaimi, Nur Dianah. "HFMD: 1,000 cases a week is unusual, says doc ". Singapore: The Sunday Times (Straits Times). (2008 April 20) p. 1-2.  Back to cited text no. 4
5.Brads Graham. Hand foot mouth disease. Available from: http://www.emedicine.medscape.com/article/1132264-overview. [Last accessed on 2011 Jan 25].  Back to cited text no. 5
6.Jayakumar Thomas. Hand-foot and mouth disease-an overview. e-Journal Indian Soc Teledermatology 2009;3(4):1-5   Back to cited text no. 6
7.Kushner D, Caldwell BD. Hand-foot-and-mouth disease. J Am Pediatr Med Assoc 1996;86:257-9.   Back to cited text no. 7
8.McKinney RV. Hand, foot, and mouth disease: A viral disease of importance to dentists. J Am Dent Assoc 1975;91:122-7.   Back to cited text no. 8
9.Faulkner CF, Godbolt AM, DeAmbrosis B, Triscott J. Hand, foot and mouth disease in an immunocompromised adult treated with acyclovir. Australas J Dermatol 2003;44:203-6.   Back to cited text no. 9
10.Higgins PG, Warin RP. Hand, foot, and mouth disease. A clinically recognizable virus infection seen mainly in children. Clin Pediatr (Phila) 1967;6:373-6.   Back to cited text no. 10
11.Wright HT Jr, Landing BH, Lennette EH, McAllister AR. Fatal infection in an infant associated with Coxsackie virus group A, type 16. N Engl J Med 1963;268:1041-4.   Back to cited text no. 11
12.Toida M, Watanabe F, Goto K, Shibata T. Usefulness of low level laser for control of painful stomatitis in patients with hand-foot-and-mouth disease. J Clin Laser Med Surg 2003;21:363-7.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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