Differential Diagnosis of Hand-Foot-Mouth Disease (HFMD)

Hand-foot-mouth disease (HFMD) needs to be distinguished from other viral exanthems which have similar appearing skin lesions.

Differential diagnosis:

(1) herpetic gingivostomatitis

(2) chickenpox

(3) herpangina

Parameters:

(1) oral involvement

(2) other involvement

(3) systemic illness

Condition	Oral Involvement	Other Findings	Systemic Findings
HFMD	buccal mucosa and tongue	involve hands and palms, less centrally	low grade
herpetic gingivo-stomatitis	oral mucosa and lips	cervical lymphadenopathy; limbs not involved	higher grade (look ill)
chickenpox	none to minor	do not involve palms or soles; central distribution	higher grade (look ill)
herpangina	involves soft palate and pharynx primarily	NA	low grade

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