What should you know about atypical hand foot and mouth?

Spots or blisters may extend beyond the hands, feet and mouth to the arms, legs, face, trunk or areas of eczema. Because the appearance can resemble chickenpox, eczema infection or other blistering conditions, a clinician may need to confirm the cause.

Hand, foot and mouth disease is caused by enteroviruses. Different viral strains and a person's skin response can alter where the rash appears and how large or crusted the lesions become. Mouth ulcers, sore throat, reduced appetite and fever may accompany the skin changes.

The infection spreads through respiratory droplets, saliva, blister fluid, stool and contaminated hands or surfaces. People can pass it on even as visible symptoms settle, so careful handwashing remains useful during recovery, especially after toileting or changing nappies.

Offer frequent cool fluids and soft foods if mouth ulcers make swallowing uncomfortable. Rest, light clothing and age-appropriate pain or fever medicine can ease discomfort; check the label and ask a pharmacist or clinician about the correct product and dose for a child. Antibiotics do not treat the virus.

Keep blisters clean, avoid deliberately breaking them and discourage scratching. Wash hands with soap and water, clean frequently touched surfaces, and do not share cups, cutlery or towels. Follow the nursery or school policy on returning, since attendance rules may differ.

Get urgent medical help for difficulty breathing, unusual drowsiness, confusion, a seizure, a stiff neck, severe headache, or a rash that does not fade when pressed. A baby who is difficult to wake or feed also needs urgent assessment.

Arrange prompt advice if drinking is poor, urine becomes infrequent, the mouth is dry, there are no tears when crying, fever persists, pain is difficult to control, or skin around lesions becomes increasingly red, warm, swollen or produces pus. These signs can indicate dehydration or a secondary skin infection.

Ask whether the rash fits hand, foot and mouth disease or needs testing for another cause. Confirm which fluids and pain relief are suitable, what changes would require reassessment, how to care for eczema under the rash, and when the child can return to childcare or school.