Snapshot An 11-year-old boy presents to clinic with a red, maculopapular rash on his feet. He complains of having a fever and feeling "tired" the day before and having a sore throat. Physical exam reveals pharyngeal erythema and a few vesicles. He has a similar rash on his palms. Introduction Common illness in childhood caused by infection with Coxsackie A virus (enterovirus) Presents first as prodrome sequence followed by classic rash Usually self-limited Presentation Symptoms prodrome mild fever poor appetite malaise sore throat oral sores develop 1-2 days after fever onset begin as small red spots that blister and ulcerate usually located on the tongue, gums, and inside of cheeks very painful rash develops over a period of 1-2 days following prodrome flat or raised red spots with some blistering not itchy usually located on the palms and soles, as well as in the mouth Physical exam as above Evaluation Diagnosis is based primarily on clinical observations and patient history Differential Other viral exanthems Treatment Medical management observation alone rash is self-limited in almost all cases and clears in about one week no specific treatment is available for this or other enterovirus infections symptomatic treatment may be indicated in some cases acetominophen for fever and aches topical anesthetic gel for mouth ulcers Prognosis, Prevention, and Complications Prognosis excellent all patients generally recover within 5-7 days of rash Prevention frequent handwashing, especially after diaper changes quarantine from other children during first few days of illness to prevent transmission Complications none