Hand, Foot & Mouth Disease vs Herpangina: Key Differences
Content reviewed against published CDC, AAP, UpToDate guidelines
Last reviewed:
Hand, foot, and mouth disease (HFMD) and herpangina are both caused by the same family of viruses (enteroviruses/coxsackieviruses) and share overlapping features. However, they differ in where sores appear and their overall presentation.
Key takeaways
- HFMD causes blisters on hands, feet, and buttocks; herpangina is limited to the mouth/throat
- Herpangina sores are concentrated in the BACK of the throat; HFMD sores are widespread throughout the mouth
- Herpangina often causes higher fever with more abrupt onset
- HFMD may cause nail peeling weeks after recovery; herpangina does not
: Cause
Hand, Foot & Mouth Disease (HFMD): Coxsackievirus A16 (most common), enterovirus 71
Herpangina: Coxsackievirus A (various serotypes), other enteroviruses
: Typical age
Hand, Foot & Mouth Disease (HFMD): Under 5 years
Herpangina: Under 5 years
: Mouth sores location
Hand, Foot & Mouth Disease (HFMD): Tongue, gums, inside cheeks, palate — widespread in mouth
Herpangina: Back of throat and soft palate only (more posterior)
: Skin involvement
Hand, Foot & Mouth Disease (HFMD): Blisters/spots on hands, feet, buttocks, sometimes legs
Herpangina: No skin blisters (mouth/throat only)
: Fever
Hand, Foot & Mouth Disease (HFMD): Moderate fever (101-103°F) for 2-3 days
Herpangina: Often higher fever (103-106°F), sudden onset
: Sore throat pain
Hand, Foot & Mouth Disease (HFMD): Moderate; spread throughout mouth
Herpangina: Severe throat pain (sores concentrated in back of throat)
: Drooling/refusal to eat
Hand, Foot & Mouth Disease (HFMD): Common due to mouth sores
Herpangina: Very common due to severe throat pain
: Duration
Hand, Foot & Mouth Disease (HFMD): 7-10 days total
Herpangina: 3-6 days (shorter duration)
: Season
Hand, Foot & Mouth Disease (HFMD): Summer and fall
Herpangina: Summer and fall
: Nail changes
Hand, Foot & Mouth Disease (HFMD): Nail shedding may occur 3-6 weeks later (benign)
Herpangina: Not typically associated with nail changes
| Hand, Foot & Mouth Disease (HFMD) | Herpangina | |
|---|---|---|
| Cause | Coxsackievirus A16 (most common), enterovirus 71 | Coxsackievirus A (various serotypes), other enteroviruses |
| Typical age | Under 5 years | Under 5 years |
| Mouth sores location | Tongue, gums, inside cheeks, palate — widespread in mouth | Back of throat and soft palate only (more posterior) |
| Skin involvement | Blisters/spots on hands, feet, buttocks, sometimes legs | No skin blisters (mouth/throat only) |
| Fever | Moderate fever (101-103°F) for 2-3 days | Often higher fever (103-106°F), sudden onset |
| Sore throat pain | Moderate; spread throughout mouth | Severe throat pain (sores concentrated in back of throat) |
| Drooling/refusal to eat | Common due to mouth sores | Very common due to severe throat pain |
| Duration | 7-10 days total | 3-6 days (shorter duration) |
| Season | Summer and fall | Summer and fall |
| Nail changes | Nail shedding may occur 3-6 weeks later (benign) | Not typically associated with nail changes |
When to Worry
- Unable to drink fluids for more than 12 hours or signs of dehydration (no tears, dry mouth, decreased urine)
- Fever lasting more than 5 days
- Headache with stiff neck and vomiting (rare complication: viral meningitis)
- Difficulty breathing or excessive drooling with inability to swallow
- Child is unusually lethargic, confused, or difficult to wake
- Widespread blistering beyond hands/feet/mouth (may be different condition)
Frequently asked questions
What is the main difference between Hand, Foot & Mouth Disease (HFMD) and Herpangina?
How can I tell if my baby has Hand, Foot & Mouth Disease (HFMD) or Herpangina?
When should I worry?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Bottom line
Both Hand, Foot & Mouth Disease (HFMD) and Herpangina are common in young children. The key differences in symptoms can help you identify what your child may have, but when in doubt, consult your pediatrician.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.