My child has blisters on his mouth. Is it hand, foot and mouth disease again?

This is the 3456th article of Da Yi Xiao Hu

A parent once asked me in the clinic: "Doctor, my child has blisters in his mouth. Could it be hand, foot and mouth disease? We really don't know how to judge the situation of herpes." Don't panic, herpes is not unique to hand, foot and mouth disease. Let's take a look at some common diseases that can cause blisters in children's mouths:

Oral herpes simplex

Oral herpes zoster

Hand, foot and mouth disease

Herpetic angina

Herpetic stomatitis

Knowledge points:

1. All three diseases are caused by viral infections, and antibiotics are ineffective, but sometimes secondary infections need to be prevented;

2. There is no specific drug in drug treatment, and symptomatic treatment is the main treatment;

3. Hand, foot and mouth disease and herpetic pharyngitis are infectious diseases. Do not let your child go to school with the disease. Stay at home for 2 weeks and do not go to crowded places.

4. Targeted vaccination is recommended, and you can visit local prevention and control centers for details.

5. Leave professional matters to professionals, and follow the doctor’s advice so that “the baby will suffer less and the parents can feel at ease.”

Oral herpes includes oral herpes simplex, oral herpes zoster, and hand, foot and mouth disease.

1. Oral herpes simplex

(Image source: https://www.sohu.com/a/201269680_677363)

Oral herpes simplex is very common in human infection, often invading the oral cavity, skin, eyes, perineum, nervous system and other parts, and humans are its natural hosts. It can be divided into primary herpetic stomatitis and recurrent herpetic stomatitis. Primary herpetic stomatitis is more common in children, especially in children under 6 years old, especially more in 6 months to 2 years old, and is often manifested as acute herpetic gingivostomatitis. There are four periods of its onset: ① Prodromal period Before the onset of the disease, there is often a history of contact with patients with herpes. After a latent period of 4 to 7 days, acute symptoms such as fever, headache, fatigue, general muscle pain, sore throat, and enlarged and tender lymph nodes under the mandible and cervical. The child drools, refuses to eat, and is irritable. After 1 to 2 days, the oral mucosa, attached gingiva and marginal gingiva are widely congested and edematous. ② Blister stage The oral mucosa presents clusters of small blisters, which are the size of a needle head, with thin, transparent and easy to rupture, forming superficial ulcers. ③ In the erosion stage, clusters of small blisters can cause large-area erosion after rupture, and can cause secondary infection. Covered by a yellow pseudomembrane. The lips and skin around the mouth may also have similar lesions, and scabs will form after the blisters rupture. ④ In the healing stage, the erosion surface gradually shrinks and heals. The entire course of the disease takes 7 to 10 days.

2. Oral herpes zoster

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Oral mucosal damage: It is easy to occur in the distribution area of ​​the trigeminal nerve. The blisters are short-lived and often manifest as an ulcer surface with irregular edges and shallow surface. The surface is covered with yellow pseudomembrane, which is limited to one side and causes severe toothache. The site of the eruption will first have pain, itching, and burning sensation, followed by flushing, and clusters of millet-sized papules will appear. They are arranged in a band along the distribution of the affected nerves and quickly turn into blisters. The blisters can merge into bullae with tense walls and clear and transparent contents. They gradually become turbid and even bloody and purulent. After a few days, the blisters are absorbed and dried up, and the crusts fall off after 1 to 2 weeks, leaving temporary erythema or pigmentation. Generally, no scars are left, and the damage does not exceed the midline.

How will your doctor treat oral herpes zoster?

(1) General treatment

Get plenty of rest, eat easily digestible food and drink plenty of water. Prevent secondary bacterial infection. Do not rub the affected area to prevent the blisters from bursting.

(2) Drug treatment

① Glucocorticoids can reduce the inflammatory response and swelling of the facial nerve in the acute stage, so as to reduce the pressure on the facial nerve in the fixed diameter bone canal, thereby reducing the degree of compression of the facial nerve bone canal and microcirculatory disorders caused by edema and thickening of the facial nerve. Therefore, glucocorticoid treatment is the first and main drug treatment for this disease. It should be used with caution by patients with diabetes, tuberculosis, gastric ulcers and pregnant women. People with hypertension should pay attention to controlling blood pressure.

② Antiviral drugs can interfere with herpes virus DNA polymerase and inhibit DNA replication. Acyclovir (acyclovir) is commonly used, and ganciclovir, famciclovir or valacyclovir (vaclovir) can also be used.

③ Neurotrophic drugs such as vitamin B1 and vitamin B12 are injected intramuscularly or taken orally.

④ Drugs to improve facial nerve microcirculation include intravenous injection or oral administration of ginkgo leaf extract or other drugs that dilate blood vessels and improve microcirculation.

⑤ Painkillers can be used appropriately when the pain is severe.

⑥Other transfer factors, normal human immunoglobulin injection.

3. Hand, foot and mouth disease

The onset is acute, accompanied by fever, scattered blisters on the oral mucosa, maculopapular rashes and blisters on the hands, feet and buttocks, with inflammatory redness around the rash and less fluid in the blisters; scattered blisters on the oral mucosa, obvious pain, some children may have symptoms such as cough, runny nose, loss of appetite, nausea, vomiting and headache.

(Image source: https://www.cn-healthcare.com/articlewm/20210629/content-1237576.html)

At this time, parents must not take it lightly, because HFMD can cause severe cases: patients with clinical manifestations of HFMD are also accompanied by myoclonus or encephalitis, acute flaccid paralysis, cardiopulmonary failure, pulmonary edema, etc. Infants and young children in HFMD-endemic areas do not have typical manifestations of HFMD. However, they may have fever accompanied by myoclonus or encephalitis, acute flaccid paralysis, cardiopulmonary failure, pulmonary edema, etc.

4. Herpetic pharyngitis

(Image source: https://www.sohu.com/a/477952111_99953540)

Herpangina is an acute infectious disease that occasionally occurs in adolescents and adults, and is more common in children aged 1 to 7 years old. The same child can be infected multiple times, and the general course of the disease is about one to two weeks. It is characterized by small papular blisters and ulcers mainly in the pharyngeal isthmus, manifested as congestion in the pharynx, and within 2 days of onset, several (1 to 2, up to more than 10) small (1 to 2 mm in diameter) gray-white herpes appear on the oral mucosa, surrounded by a red halo. After 2 to 3 days, the red halo intensifies and expands, and the herpes rupture to form yellow ulcers. This mucosal rash is more common in the anterior column of the tonsils, and can also be located on the soft palate, uvula, and tonsils, but does not involve the gums and buccal mucosa. Some children with hand, foot and mouth disease have herpangina as the first symptom, and then red rashes may appear on the palms, soles, buttocks and other parts. Older children may complain of sore throat, and severe sore throat may affect swallowing. Infants and young children show drooling, refusal to eat, and irritability. Sometimes accompanied by headache, abdominal pain or myalgia, 1/4 of children under 5 years old may have vomiting. Fever often occurs rapidly, lasting 2 to 4 days, and the fever is usually low or moderate, occasionally reaching 40°C or above, and even causing convulsions.

5. Herpetic stomatitis

Herpetic stomatitis is a disease caused by herpes simplex virus infection that damages the oral mucosa. More than 90% of cases are caused by herpes simplex virus type 1, and are most obvious on the palate and gingival margin near the primary molars. Children under 6 years old are the most susceptible group to herpetic stomatitis. It usually lasts for 7 to 14 days.

For the above diseases, parents can help their children take good care of their oral cavity and fever under the guidance of a doctor:

1. Oral Care

1. Oral care requires attention to diet. Generally, the diet is mainly liquid or semi-liquid food, such as rice soup, rice paste, etc. These foods are good for digestion and will not cause oral irritation. However, it should be noted that the temperature of the food should not be too high, and dry, hard, fried, or greasy food should not be eaten.

2. Oral care also requires gargling with light salt water every morning to flush out the virus in the mouth. In addition, it is necessary to replenish fluids in a timely manner, preferably in small amounts and multiple times. If oral ulcers already appear, you can use some medications appropriately. You can choose drugs that can reduce inflammation, repair ulcer surfaces, and relieve pain.

2. Fever Care

1. Physical cooling: If the child's fever exceeds 37°C, you can use a hot towel to wipe the neck, back and other parts near the aorta, so that the water can take away the excess heat in the body. Just use a little force when wiping, which can increase the sweating speed, but don't use too much force to avoid abrasions.

2. Medication to reduce fever. If the child's fever temperature exceeds 38.5℃, medication can be used to reduce the temperature. In the medication selection sector, you can give your child acetaminophen or ibuprofen to reduce fever according to the doctor's advice. If one medication is not effective in reducing the temperature, you can use two medications to reduce the temperature. Just make sure the interval between medications is not less than 4 hours, and pay attention to the amount of medication.

I believe that after careful and patient oral care and cooling treatment by parents, the condition can be well controlled, and combined with certain medications, the child's herpes can be cured. In terms of drug selection, you should also listen to the doctor's advice and not use drugs blindly. Dear studious parents, have you learned it?

Author: Yuan Ying, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, standardized training resident physician, master's student. Research direction: precocious puberty, dwarfism and spleen and stomach diseases in children.

Editor-in-chief and tutor: Shen Jian, Department of Pediatrics, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Director of Teaching, Associate Chief Physician. Doctor of Medicine, Master Supervisor. National TCM Innovation Core Talent of the Central Administration of Traditional Chinese Medicine Inheritance and Innovation "Hundreds of Thousands" Talent Project. The popular science monograph "The Wisdom of Traditional Chinese Medicine that Good Mothers Should Know" won the 10th Healthy China Forum and the First Annual Outstanding Popular Science Work Award.