Hand, Foot and Mouth Disease vs. Impetigo - How to Tell the Difference

Hand, Foot and Mouth Disease vs. Impetigo

Hand, foot and mouth disease and impetigo are two common skin conditions, especially among children. Their similar signs and symptoms can make it tricky to distinguish between them. But there are key differences between these contagious diseases.

Understanding the causes, appearance, locations and spread of hand, foot and mouth versus impetigo helps identify which one your child may have. Getting an accurate diagnosis ensures proper treatment and management.

What is Hand, Foot and Mouth Disease?

Hand, foot and mouth disease (HFMD) is a mild viral infection causing sores in the mouth and a rash on the hands and feet. It is most common in children under 5 years old.

HFMD is caused by viruses in the enterovirus family, such as Coxsackie A16 virus or Enterovirus 71. It spreads through:

Coughing and sneezing

Contact with nose and throat discharges

Exposure to feces

Contaminated objects and surfaces

Symptoms of HFMD usually appear 3-6 days after exposure to the virus. They include:

Fever

Sore throat

Loss of appetite

Painful mouth ulcers

Blister-like rash on palms, fingers, soles and toes

HFMD typically resolves on its own within 7-10 days without treatment. Maintaining hydration and using over-the-counter pain medication helps manage symptoms.

What is Impetigo?

Impetigo is a highly contagious bacterial skin infection causing blistering lesions. The bacteria Staphylococcus aureus or Streptococcus pyogenes infect the superficial layers of skin.

Impetigo spreads through:

Close contact with infected persons

Touching sores then other parts of the body

Using contaminated towels, clothing or toys

Impetigo has two main forms - nonbullous and bullous. Symptoms include:

Nonbullous - clusters of sores, yellow crusting, scabbing, itching

Bullous - large, painless, fluid-filled blisters that rupture easily

Impetigo most often affects the face, especially around the nose and mouth. But sores can appear elsewhere like hands, legs and diaper area.

Antibiotics, prescribed oral medication or topical ointment, treat impetigo infections and help prevent spreading. Prompt treatment within 24 hours is key.

Comparing Causes

HFMD and impetigo have different underlying causes:

HFMD

- Caused by viruses like Coxsackievirus A16 or Enterovirus 71

Impetigo

- Caused by Staphylococcus or Streptococcus bacteria

While both are highly contagious, HFMD stems from a viral infection while impetigo is a bacterial skin infection.

Comparing Symptoms and Signs

There are some overlaps in symptoms but also distinguishing differences:

HFMD

- Begins with fever, sore throat, malaise

- Painful red spots or ulcers in mouth

- Rash of vesicles on hands, feet, buttocks

- Rarely itchy

Impetigo

- No fever or flu-like symptoms

- No mouth ulcers

- Blistery, itchy rash

- Golden yellow crusts and scabs

While both cause blister-like rashes, HFMD has more systemic symptoms first before the rash appears. Impetigo jumps right to very itchy, blistering skin lesions.

Comparing Locations

Where the rashes appear differs slightly between the two:

HFMD Rash

- Starts on palms, fingers, soles, toes

- Spreads to knees, elbows, buttocks, genitalia

- Occurs on hands, feet and mouth

Impetigo Rash

- Favors face, especially around nose and mouth

- Also arms, legs, trunk, diaper area

- Rarely affects palms, soles and mouth

While HFMD rashes favor the hands, feet and oral cavity, impetigo concentrates more on the face and limbs while sparing the palms, soles and mouth.

Risk Factors

Certain factors increase risk of contracting these contagious conditions:

HFMD

- Age under 5 years old

- Child in daycare setting

- Compromised immunity

Impetigo

- Young children 2-5 years old

- Hot, humid environments

- Poor hygiene

- Broken skin

While both affect mainly young kids, impetigo thrives more in tropical settings among those with poor hygiene and pre-existing skin damage.

Comparing Contagiousness

HFMD and impetigo are two of the most contagious skin conditions in children. But impetigo may be slightly more transmittable.

HFMD

- Highly contagious virus

- Spreads through respiratory secretions and feces

- Contagious during acute phase, about 1 week

Impetigo

- Extremely contagious bacteria

- Spreads by touch, clothing and surfaces

- Remains contagious until treated

Both are very easily spread through direct contact, droplets and contaminated fomites. But untreated impetigo poses greater transmission risk until antibiotics are started.

Comparing Diagnosis

Doctors diagnose based on presentation, labs and tests:

HFMD

- Clinical appearance

- Swabs of mouth ulcers

- Viral culture

- Polymerase chain reaction (PCR)

Impetigo

- Appearance of rash

- Swab of skin lesions

- Bacterial culture

- Antibiotic susceptibility

Doctors may use samples, cultures or PCR to identify the specific viruses causing HFMD or the bacteria behind impetigo lesions.

Comparing Treatment

Treatment approaches differ significantly between the viral and bacterial infections:

HFMD Treatment

- Supportive care - fluids, rest, fever control

- Antiviral medication not useful

- Resolves on its own in 7-10 days

Impetigo Treatment

- Antibiotic ointment or oral medication

- Cleansing sores

- Trim fingernails to prevent spreading

- Daily treatment for 6-10 days

While HFMD is managed with symptom relief, impetigo requires antibiotics to eradicate the bacterial infection.

Comparing Complications

Serious complications are uncommon with either condition. But impetigo can progress to deeper infections or sepsis if untreated.

HFMD Complications

- Typically resolves without incident

- Rarely leads to viral meningitis

Impetigo Complications

- Cellulitis, lymphangitis, abscesses

- Glomerulonephritis

- Sepsis

Impetigo poses greater risk for invasive infections and kidney inflammation if skin lesions aren't quickly treated and contained.

Preventing Transmission

Limiting spread of HFMD and impetigo involves:

General Prevention

- Good hand hygiene

- Avoid touching face and lesions

- Regular cleaning of surfaces

- Not sharing towels, toys, pacifiers

- Trimming nails short

HFMD Prevention

- Isolate infected child

- Disinfect mouthed toys

- Avoid kissing child

Impetigo Prevention

- Cover lesions with bandages

- Discard contaminated dressings

- Avoid school until treated

Isolation, hygiene and disinfection limit transmission, along with specific measures to contain viral or bacterial spread through secretions, sores and surfaces.

When to Seek Medical Care

Consult a doctor if your child experiences:

HFMD

- High fever > 104 F

- Excessive drooling

- Difficulty swallowing

- Headaches, stiff neck

Impetigo

- Extensive or worsening rash

- Signs of infection - fever, redness

- No improvement on antibiotics

Seek urgent care for symptoms of meningitis, sepsis or kidney inflammation. Call your doctor if normal recovery stalls.

The Takeaway

On the surface, HFMD and impetigo may seem interchangeable due to similar oral and skin manifestations. But recognizing key differences in their causes, symptoms, locations, spread and treatment enables accurate diagnosis. While usually benign, impetigo does carry higher complication risks without antibiotic management. Consult your doctor to differentiate these childhood skin conditions and ensure optimal recovery.

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.