Questionnaire/history:

Prodromal period (12-36 hours)?

- Fever (typically 38-39°C)?

- Sore throat?

- Sore mouth?

- Malaise?

- Loss of appetite?

- Cough?

- Abdominal pain?

- Vomiting (rarely, if caused by enterovirus 71)?

Tender lesions in the mouth (enanthem) and/or rash (exanthem)?

Mouth lesions?

- 2-8 mm erythematous macules and papules?

- Vesicles, which readily erode leaving shallow yellow-grey ulcers surrounded by an erythematous halo (within 1-2 days)?

Rash?

- 2-5 mm sparse erythematous macules and papules (often with a central greyish vesicle) of the hands and feet usually soon after oral lesions?

- Sides of the fingers, dorsum of the hands and margins of the heels more affected than the palms or the soles?

- Lesions frequently elliptical with the long axis running parallel to the skin lines? - Buttocks and groin area also affected (may be)?

- Lesions may be asymptomatic or painful?

- More widespread rash that extends beyond the palms and soles and may preferentially occur in areas prone to atopic dermatitis (antecubital and popliteal foassae) (if caused by Coxsackie virus A6)?

Past medical history?

Current medication?

Drug allergies?

Examination:

Temperature?

Mouth lesions (as above)?

Rash (as above)?

Images

Management:

Urgent hospital admission if symptoms or signs of central nervous system involvement, such as:

- Persistent or severe headache or fever

- Myoclonus with sleep disturbances

- Confusion, weakness, lethargy, drowsiness, irritability, generalized seizures, and

coma (may suggest encephalitis)

Advised:

- FHMD usually a mild, self-limiting illness

- To read information available from NHS and Patient UK

- Ensure fluid intake is adequate

- Consider hospital admission if signs of significant dehydration like reduced urine

output, lethargy, cold peripheries or reduced skin turgor

- Soft diet may be necessary if mouth ulcers are painful

- Foods that are hot, spicy, salty, or acidic may cause oral pain

- Paracetamol or ibuprofen, if required, to reduce fever and pain

- Measures to reduce the risk of transmission:

- Ensure that hands are washed and dried thoroughly after using the toilet and

before eating

- Ensure the mouth and nose are covered when coughing and sneezing

- The nose and mouth should be wiped with disposable tissues, and then hands washed

- Particular care when handling nappies and tissues

- Soiled clothes, bedding, and towels should be washed on a hot cycle of the washing machine

- Cups, eating utensils, towels, and clothing should not be shared

- Blisters should not be deliberately pierced, as the fluid is infectious

- Pregnant women should avoid close contact with any person with hand, foot, and mouth disease

- Children do not need to be excluded from nursery, childcare, or school for infection control purposes

- Children should not attend nursery, childcare or school if they are too unwell to attend

- No need to isolate the child (for example excluding visitors or household contacts) or investigate close contacts

- To contact the local Public Health England (PHE) centre if a large number of children are affected, and an outbreak is suspected

- To seek medical advice if becoming dehydrated or more unwell, or if oral ulcers persist for more than 3 weeks

Reference(s):

NICE CKS: Hand foot and mouth disease

Information for patient/carer(s):

NHS Health A to Z: Hand, foot and mouth disease

Patient UK: Hand, foot and mouth disease