Hand, Foot, and Mouth Disease: Symptoms on Black Skin in African Americans

Nov 06, 2025 0

Hand, foot, and mouth disease (HFMD) is a common and highly contagious illness caused by viruses. It primarily affects young children, but people of any age can contract it. This article provides a detailed overview of HFMD, its symptoms, and specific considerations for recognizing the condition on black skin in African Americans.

Overview of Hand, Foot, and Mouth Disease

HFMD is a mild illness caused by viruses, most often by a virus called coxsackievirus A16. Other types of enteroviruses may also cause HFMD. The viruses spread easily between people and through the air. HFMD is most common in children in child care settings because young children need frequent diaper changes and help using the toilet, and they tend to put their hands in their mouths.

Hand, foot, and mouth disease (HFMD) is a highly contagious, globally epidemic disease that primarily affects children under 5 years old. Hand-foot-and-mouth, or HFMD, normally causes fever in kids, along with sometimes painful sores in the mouth.

Hand, foot, and mouth disease, or HFMD, is a contagious illness that is caused by different viruses. HFMD is a common illness that usually causes fever, mouth sores, and skin rash. HFMD is usually not serious. Most people get better on their own in 7 to 10 days with minimal or no medical treatment.

Hand, foot, and mouth disease is a contagious infection that causes blisters and sores and tends to occur most often in young children.

Viruses that cause the illness spread easily between people and through the air. Most people get the coxsackievirus infection - and hand-foot-and-mouth disease - through the mouth via:

Nose secretions or throat discharge.
Saliva.
Fluid from blisters.
Stool.
Droplets sprayed into the air after a cough or sneeze.

Your child is most contagious during the first week of having hand-foot-and-mouth disease, but the virus can stay in the body for weeks after the symptoms go away, meaning your child can still infect others.

Some people, especially adults, can pass the virus without showing any symptoms of the disease. Outbreaks of the disease are more common in summer and early autumn. In tropical climates, outbreaks occur during the rainy season.

Age is the main risk factor for hand-foot-and-mouth disease. The disease mostly affects children younger than ages 5 to 7 years. Children in child care settings are especially at risk because the viruses that cause the illness spread by person-to-person contact.

Older children and adults are thought to have immunity against hand-foot-and-mouth disease. Their bodies often make protective proteins called antibodies after being exposed to the viruses that cause the disease. But teenagers and adults sometimes still get hand-foot-and-mouth disease.

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Common Symptoms of HFMD

Symptoms usually appear 3 to 6 days after infection. Hand-foot-and-mouth disease may cause all of the following symptoms or just some of them.

Symptoms of hand, foot, and mouth disease often include:

Fever.
Reduced appetite.
Sore throat.
A feeling of being unwell.
Painful sores in the mouth that usually begin as flat red spots.
A rash of flat red spots that may blister on the palms of the hands, soles of the feet, and sometimes the knees, elbows, buttocks, and/or genital area.

Infants and toddlers with hand-foot-and-mouth disease may be fussy. At any age, children may get a fever and develop a sore throat. They sometimes lose their appetites and don't feel well.

One or two days after the fever begins, painful blister-like lesions may form in the front of the mouth or throat, including the tongue, gums, and inside of the cheeks. A rash on the hands and feet and sometimes on the buttocks also may appear. The rash is not itchy, but sometimes it has blisters.

Hand, Foot, and Mouth Disease, Causes, Signs and Symptoms, Diagnosis and Treatment,

Recognizing Symptoms on Black Skin

Depending on skin tone, the rash may appear red, white, or gray. The spots can be harder to see on darker skin tones, so it’s easier to check the palms of hands and the bottom of feet where the condition may be more noticeable.

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Hand-foot-and-mouth disease often causes a rash of painful, blister-like lesions on the palms of the hands and on the soles of the feet. But the rash does not necessarily appear in all three areas, and can appear on the arms and legs as well as on the buttocks.

Atypical Manifestations of HFMD

Apart from general symptoms such as fever, the most typical symptom is a rash on specific areas such as the hands, feet or/and mouth. However, the morphology and distribution of vesicles, as well as accompanying symptoms, are varied among atypical HFMD.

An upsurge in atypical presentations of HFMD caused by Coxsackievirus A6 (CVA6), including Gianotti-Crosti-like eruptions, eczema coxsackium, petechial/purpuric eruption, and vesiculobullous exanthema, can be difficult to diagnose clinically as it may mimic other severe skin diseases, such as eczema herpeticum, varicella, disseminated zoster, and erythema multiforme major.

Clinicians must identify the wide range of cutaneous and mucosal alterations caused by atypical HFMD. Here are some atypical presentations:

Gianotti-Crosti-like eruptions: Skin lesions similar in distribution to Gianotti-Crosti syndrome, involving the cheeks, extremities, and buttocks, but the trunk remains unaffected.
Eczema coxsackium: Blisters in the area of eczematous dermatitis, similar to herpetic eczema caused by the herpes simplex virus (HSV).
Petechial/purpuric eruptions: Single blisters or concentrated blisters in some areas affected by atopic dermatitis or hemorrhagic or purpuric lesions.
Vesiculobullous exanthema: Large blisters on limbs, trunk or buttocks, and facial papules accompanied by fever, stomatitis and sore throat.

With the emergence of new pathogens or the recombination and evolution of classical viruses, the clinical characteristics of HFMD may also change a lot, which poses a challenge for correct and timely diagnosis.

Treatment for Hand, Foot, and Mouth Disease

There's no specific treatment for hand-foot-and-mouth disease. Most people get better in 7 to 10 days. But certain medicines can ease pain and general discomfort in the meantime.

While there is no specific cure for hand, foot and mouth disease, you can keep your child comfortable until the illness resolves by following these tips:

Treat mouth pain so that your child drinks well and avoids dehydration. Acetaminophen (e.g., Tylenol®) and ibuprofen (e.g., Motrin®, Advil®) are effective pain medicines.
For toddlers and older kids, offer soft foods such as yogurt, pasta, pudding or smoothies as well as ice pops to provide sustenance and relieve pain.
Offer your child a variety of fluids, keeping in mind if your child is not eating, water alone does not provide energy for the body nor does it provide the salt needed to maintain blood pressure.

The worst of the mouth pain typically occurs during the first three to five days of illness. Antibiotics and other medications do not kill this virus.

In most cases, the infection will go away without treatment in 7 to 10 days. However, your doctor may recommend certain treatments to help ease symptoms until the disease has run its course. These can include:

Prescription or over-the-counter topical ointments to soothe blisters and rashes
Pain medication, such as acetaminophen or ibuprofen, to relieve headaches
Medicated syrups or lozenges to ease painful sore throats

You shouldn’t give aspirin to children for viral infections. Aspirin can lead to Reye’s syndrome in children.

Certain at-home treatments can also provide relief from HFMD symptoms. You can try the following home remedies to help make blisters less bothersome:

Sucking on ice chips or popsicles
Eating ice cream or sherbet
Drinking cold beverages
Limiting citrus fruits, fruit drinks, and soda
Limiting spicy or salty foods

Swishing warm salt water around in your mouth may also help relieve the pain associated with mouth blisters and throat sores. You can do this several times a day or as often as needed.

Prevention of HFMD

Help prevent hand-foot-and-mouth disease with frequent hand-washing. Also, stay away from people who are sick.

The best way to limit the spread of the virus is through frequent handwashing. Adults can get hand, foot and mouth disease too, so you should also wash your hands frequently, both while caring for your child and after changing diapers.

Tips to prevent hand, foot and mouth disease:

Wash hands often for at least 20 seconds after using the toilet or changing a diaper, before preparing or eating food, and after blowing your nose, sneezing, or coughing. When soap and water aren't available, use hand sanitizer.
Teach good hygiene. Show your children how to wash their hands and help them do it often. Show them how to practice overall good hygiene. Explain to them why it's best not to put their fingers, hands, or any other objects in their mouths. Also tell them not to touch their eyes, noses and mouths.
Disinfect common areas. Clean high-traffic areas and surfaces first with soap and water. Next, clean with a diluted solution of chlorine bleach and water. If you're in a child care setting, follow a strict schedule of cleaning and disinfecting. The virus can live for days on surfaces in common areas, including on doorknobs. The virus also can live on shared items such as toys.
Don't have close contact with sick people. Viruses that cause hand-foot-and-mouth disease can spread easily. So, people with the illness should try to stay away from others while they have symptoms. Keep children with hand-foot-and-mouth disease out of their child care settings or schools. Don't let them go back until the fever is gone and mouth sores have healed. If you have the illness, stay home from work.

When to See a Doctor

Most often, hand-foot-and-mouth disease is a minor illness. It typically only causes fever and mild symptoms for a few days. You or your child should feel completely better 7 to 10 days after the initial onset of symptoms. Getting the infection again is uncommon.

Call a doctor immediately if symptoms get worse or don’t clear up within 10 days. In rare cases, coxsackievirus can cause a medical emergency.

See a doctor if:

Your child is younger than six months.
Your child has a weakened immune system.
Fever doesn't get better in three days.
Mouth sores or a sore throat makes it painful for your child to drink fluids.
Your child's symptoms cause a lot of discomfort.
Your child's symptoms don't get better after 10 days.

Potential complications of HFMD include:

Dehydration
Fingernail or toenail loss
Viral meningitis
Encephalitis
Paralysis
Myocarditis

HFMD Atypical Presentations Caused by CVA6

A variety of pathogens could cause atypical HFMD, but CVA6 has been commonly reported. The table below details the atypical presentations caused by CVA6.

Atypical Presentation	Description	Symptoms
Gianotti-Crosti-like eruptions	Skin lesions similar in distribution to Gianotti-Crosti syndrome	Papules or papular injuries on the extensor side of the forearm, extensor side of the leg, cheek or buttocks.
Eczema coxsackium	Blisters in the area of eczematous dermatitis	Blisters in areas affected by atopic dermatitis.
Petechial/purpuric eruptions	Single or concentrated blisters in areas affected by atopic dermatitis or hemorrhagic or purpuric lesions	Purpuric rash around the mouth, trunk, neck, and feet.
Vesiculobullous exanthema	Large blisters on limbs, trunk or buttocks, and facial papules	Bullae on the bottom of feet, face, buttocks, and trunk.