Hand Foot and Mouth vs Impetigo - Differences and Similarities

What is Hand, Foot and Mouth Disease?

Hand, foot, and mouth disease (HFMD) is a mild, highly contagious viral infection commonly seen in infants and children under 5 years old. It is caused by intestinal viruses from the enterovirus family, most notably the coxsackievirus.

HFMD causes a characteristic rash or sores involving the hands, feet, mouth, and sometimes buttocks. Additional symptoms can include fever, sore throat, loss of appetite, and feeling unwell.

Transmission occurs through contact with infected nose and throat secretions, saliva, blister fluid, or stool of someone carrying the virus. It typically runs its course in 7-10 days without treatment.

Common Signs and Symptoms

• Fever
• Sore throat
• Painful mouth sores/ulcers
• Skin rash with vesicles (blisters)
• Fatigue, fussiness

What is Impetigo?

Impetigo is a common, highly contagious bacterial skin infection most often seen in young children ages 2-5. The bacteria Staphylococcus aureus or Streptococcus pyogenes invade the skin through cuts, scrapes, or insect bites.

Impetigo leads to red sores on the face (particularly around nose and mouth) that rupture, ooze, and form honey-colored crusts. Itching is common. The infection can spread rapidly to other areas through touch.

Without treatment, impetigo typically resolves on its own in a couple weeks but antibiotics speed healing and lower transmission rates. Complications like cellulitis or kidney inflammation occasionally occur.

Common Signs and Symptoms

• Clusters of small, red bumps or blisters
• Golden yellow crusts on rash areas
• Itching, sore spots
• Scabbing over infected areas

How are HFMD and Impetigo Similar?

Despite being very distinct infections, HFMD and impetigo share quite a few similarities that cause confusion or lead to misdiagnosis. These are some of the main ways they overlap:

Age Group Affected

Both HFMD and impetigo more commonly affect infants and young children, rather than teens or adults. Immune systems and hygiene habits are still developing at a young age, increasing susceptibility.

Appearance of Rash

The initial small bumps and red lesions that appear in the early stages of each condition resemble each other before other distinguishing characteristics emerge. Obtaining an accurate timeline of symptom progression is helpful.

Body Areas Involved

HFMD and impetigo frequently involve the face and areas around the mouth when lesions first erupt. Both also commonly spread to the arms, legs, hands and feet - partly due to greater pathogen exposure of these areas through touch and abrasions.

High Contagiousness

The viruses and bacteria responsible for HFMD and impetigo spread very easily through direct skin contact, contaminated surfaces, coughing, sneezing, or sharing items. Children in daycares and schools transmit them rapidly.

How Do HFMD and Impetigo Differ?

Despite some superficial resemblances, HFMD and impetigo have distinct causes and clinical symptoms that aid in telling them apart accurately. Here is how the conditions differ:

Cause and Type

The primary difference lies in the causative pathogens - HFMD stems from intestinal non-polio enteroviruses while impetigo results from Staph or Strep skin bacteria. One is a viral infection, the other bacterial.

Systemic Symptoms

Fevers, body aches, sore throat, lethargy often accompany HFMD but don’t typically occur with impetigo. This signifies HFMD is a systemic condition while impetigo is localized to the skin.

Nature of Lesions

The skin lesions of HFMD start as small red/white bumps or vesicles that rupture into ulcers/blisters. Impetigo leads to honey-crusted plaques, yellow scabs, and thick drainage from large blisters which are telltale signs.

Duration

Left untreated, HFMD typically self-resolves within 7-10 days as viruses run their course while impetigo can continue spreading for 2+ weeks. Antibiotics rapidly cure impetigo so shorter duration with treatment.

Complications

HFMD very rarely has medical complications, although handwashing is key to avoid viral transmission. Impetigo can lead to surrounding cellulitis, sepsis, or kidney problems in severe cases needing prompt treatment.

When to See a Doctor

While most cases of HFMD and impetigo resolve on their own over a couple weeks, contacting a pediatrician for evaluation is warranted if:

• Symptoms worsen or haven’t improved in over 10 days
• Fever above 101 F, body aches, or flu-like symptoms develop
• Very painful, widespread, or rapidly spreading skin lesions appear
• Child becomes lethargic, confused, or struggles eating/drinking
• Blisters and sores recur frequently

Seeking medical attention promptly for worsening skin changes allows quick treatment if a secondary bacterial skin infection has also set in alongside HFMD or impetigo viruses and bacteria.

Is HFMD Related to Foot and Mouth Disease?

No - hand, foot and mouth disease bears no relation to a highly contagious viral livestock illness called foot and mouth disease (FMD) that affects cattle, pigs, sheep, and other cloven-hooved animals. The names sound similar by coincidence.

FMD only infects certain farm animals while HFMD only spreads between humans. Neither illness poses any cross-transmission risks between species (animal-to-human or vice-versa).

How are HFMD and Impetigo Diagnosed?

Doctors can often reliably diagnose HFMD or impetigo simply through a thorough history of symptoms and visual exam of the skin lesions. The appearance and body location of blisters/sores allows experienced physicians to tell them apart.

However, if the diagnosis remains uncertain, samples of fluid or scrapes from lesions might get tested for viruses or bacteria. Blood tests check for elevated white cell levels indicating infection. Cultures confirm which microbes are causing symptoms.

Treatment Options and Home Care

HFMD Treatment

Currently, no direct antiviral medications exist capable of eradicating enteroviruses that cause HFMD. Supportive home treatment focuses on relieving symptoms until the infection runs its course:

• Oral pain relief (acetaminophen) for sore throat or mouth ulcers
• Topical numbing medication for skin lesions/blisters
• Adequate fluid intake
• Soft diet if eating aggravates mouth ulcers
• Bed rest as necessary

Impetigo Treatment

Doctors often prescribe topical antibiotic ointment like mupirocin or oral antibiotics such as penicillin or cephalexin to treat impetigo. Treatment aims to curb infection spread and prevent complications by destroying Staph/Strep bacteria. Home care measures include:

• Applying antibiotic ointment 3-4x daily
• Covering lesions with gauze to prevent crusting/oozing onto others
• Oral antibiotics for widespread infections per doctor’s orders
• Acetaminophen to reduce skin pain if necessary
• Frequent handwashing

Similarities in Home Care

• Resting, fluid intake and light diet
• Fever management with acetaminophen
• Avoiding scratching lesions to limit spread/scarring
• Gentle cleansing of affected skin areas
• Keeping fingernails short and clean
• Laundering clothes, bedding to prevent reinfection

Risk Factors and Preventive Steps

HFMD and Impetigo Risk Factors

Certain factors that raise susceptibility to contracting HFMD or impetigo include:

• Being an infant/toddler when immunity not fully developed
• Attending daycare or school settings
• Not diligently washing hands or skin wounds
• Living in hot, humid environments
• Having inflammatory skin disorders like eczema
• Being run down from poor diet or lack of sleep

Preventive Measures

Taking appropriate precautions can lower chances of exposure to viruses and bacteria responsible for these contagious childhood skin infections:

• Frequent handwashing with soap and warm water
• Promptly treating any skin wounds, cuts or abrasions
• Avoiding sharing beverages, food, linens, or bath items
• Disinfecting high-touch surfaces, toys and school items
• Avoiding contact sports, swimming during outbreaks
• Staying home when sick until recovered

Vaccines aren’t yet available for HFMD or impetigo.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.