Adult Hand, Foot and Mouth Disease

What is Hand Foot and Mouth Disease (HFMD)?

It is a highly contagious, common childhood infection of the mouth, skin of the hands and feet. It occurs worldwide, but in temperate climates, it is more usual in summer and autumn.

What causes it?

HFMD is often caused by the group A Coxsackieviruses (particularly A16) or the closely related enterovirus 71 (EV71). Occasionally it can be caused by other group A and B Coxsackieviruses particularly A6 and A10.

How is it transmitted?

Most commonly through the faecal-oral route, either from ingestion of infected:

• nasal/throat secretions
• saliva
• fluid from blisters
• stool (e.g. changing nappies)
• droplets following a cough/sneeze.

The incubation period is 3 – 5 days; meaning you will probably start to feel lousy 3 days after catching the virus, and the rash will usual appear by day 5.

Symptoms

You might start with a fever (temperature over 38°C / 100.4°F) and feel generally flu-like with body aches and pains, abdominal pain, diarrhoea and lose your appetite. Red spots then appear on the tongue and inside the mouth, and can sometimes be around the lips and chin. These spots quickly develop into larger typical mouth ulcers (pale yellow-grey sores with red edges). The ulcers can be painful and make eating, drinking and swallowing difficult. Ulcers around the mouth / chin can become crusted as they heal. Around the time that the mouth ulcers appear, you might develop a rash made up of small, raised red spots on the fingers, backs or palms of your hands, soles of your feet and occasionally on the buttock and genitalia. The spots may then turn into small blisters or join up to make several large grey blisters. The spots and blisters can be itchy or burning and typically last up to 10 days. Up to a week after the blisters have gone, the (now dead) top layers of skin start to peel off. This can make you feel like a snake shedding it’s skin with swathes of thin skin layers coming off! The new skin underneath is quite delicate and sore, especially if changing nappies / constantly washing hands so make sure you protect your fingertips as much as possible. Interestingly, smartphones’ Fingerprint Authentication often won’t recognise your newer skin’s biometrics so make sure you register a new fingerprint!

Diagnosis

Diagnosis is clinical, meaning the Doctor makes the diagnosis based on a typical history of HFMD and on examination, the patient has the classical features of HFMD. Laboratory testing is only required if the Doctor is concerned about exposure to EV71 (the more severe form of HFMD.)

Treatments

The illness is generally mild, and treatment is mainly supportive to ease the symptoms. General advice includes:

• drink plenty of fluids to avoid dehydration. Sucking on ice cubes / lollies can help soothe and hydrate at the same time.
• eat soft foods such as mashed potatoes, yoghurt and soups if eating and swallowing is uncomfortable. Avoid salty, acidic or spicy foods.
• take over-the-counter painkillers, such as paracetamol or ibuprofen, to ease the sore mouth and fever.
• try gargling with warm, salty water to relieve mouth discomfort.
• use mouth gels, rinses or sprays (e.g. Difflam) specifically designed for mouth ulcers – these are available from pharmacies.

Infectivity / Exclusion policies

The spread of HFMD may be reduced if children are kept at home during the first few days of illness. Which is usually when they have mouth ulcers and drool, or if they have weeping blisters on their hands. However, this will not prevent the infection from spreading, since the virus may persist in their faeces for up to 1 month. Therefore Public Health England’s guidance on ‘Infection Control in Childcare Settings’ states that there is no recommended period to be kept away from school, nursery or child-minders, and exclusion is only considered in special circumstances. Adults with the condition should stay away from work until they are feeling better.

Vaccination

In Eastern and South-East Asian countries, EV71 is responsible for a more severe version of the disease with serious complications; however, this is uncommon in the US and Europe. Following a large outbreak in China in 2009, they took the lead on developing a vaccine, and in December 2015, the Chinese Food and Drug Administration approved the first vaccine against EV71, which had good results. There is currently no vaccine against HFMD available in the UK.

“Symptoms are less severe in adults” – Wrong!

The literature states that HFMD should be less severe in adults as most will have developed immunity against the virus during their lifetimes. However in my extensive experience as a GP, and some first-hand reports from colleagues and friends, I can say that getting HFMD as an adult is pretty awful so my sympathies go out to any parents catching this from their child. Adults seem to be split into 2 camps – those with a terrible sore mouth and not much on their hands and feet; and those with awful, blistering hands and feet who can barely bend their fingers or open jars, but minimal (if any) mouth ulcers. What I do know is that is seems to last longer and be much more painful than it is in children. So, along with the general treatment options mentioned above, especially for adults with HFMD:

• Gargle with, then swallow dissolvable aspirin
• Take stronger prescription painkillers e.g. naproxen or codeine
• Try prescription steroid tablets called Corlan Pellets which contain 2.5mg hydrocortisone which stops the swelling. You let the tablet dissolve in your mouth and it can be used up to 4 times a day.
• Anaesthetic gel can be prescribed (e.g. 2% lidocaine) which you apply directly on to the mouth ulcers with a cotton-tip up to 3 times a day. This is not so practical though if many of the ulcers are at the back of your throat.

Practical advice:

• If having to change nappies of the child that gave it to you, try not to get your hands wet so wear disposable vinyl gloves over cotton inner gloves so you don’t have to wash your hands so much.
• Cotton gloves and socks can also be used at night to put over hands and feet covered in cooling moisturiser, so it soaks in whilst you sleep and doesn’t mess up your bed linen.
• One colleague said running her hands under a cold tap for as long as you can (like you would treat a scald) really helped the sting.
• Wrap an ice pack in a tea towel around your hands (or feet) to cool the throbbing blisters.

If you and/or your child are suffering from HFMD, do not hesitate to get in touch with us for help.