Nikhil Thatte
Medical Science Department, Pediatric Oncall, Mumbai


The virus particles are implanted initially in the buccal and ileal mucosa. From here, they spread into the blood stream via the regional lymph nodes. Within 72 hours, viremia is established and the virus reaches the skin and oral mucosa causing the characteristic lesions. (4)


Symptoms
Initially, the presentation is with constitutional symptoms like fever, malaise, body ache, anorexia and sore throat. This is followed by the development of the oral and skin lesions. Patients present with very small blisters on hands, feet, and diaper area. The rash may be painful if pressed.

Signs
Oral lesions: These are seen on the labial and buccal mucosal surfaces. Other sites -Tongue, gums, uvula, anterior tonsillar pillars, palate.

Nature of lesions: Yellow ulcers surrounded by red halos.

Skin lesions: These are typically seen on the dorsal aspects of the hands and feet as well as the diaper area. They may appear on the ventral and inter-digital surfaces as well. The rash may be asymptomatic or pruritic. Initially, erythematous macules that rapidly progress to thick-walled grey vesicles with an erythematous base. (5) The rash resolves by itself within 3-6 days.