Herpangina

Background
  • Caused by coxsackievirus
  • Similar to Hand, Foot, and Mouth Disease but without skin lesions

Clinical Features
  • Prodrome
  • Rash appears 24-48hr after prodrome
    • Vesicles 1-2 mm in size that rupture leaving shallow, painful whitish ulcers on soft palate/posterior pharynx
    • Similar to hand, foot, mouth disease but with out skin lesions
  • Lasts 7-10d

Differential Diagnosis

Pediatric Rash

Evaluation
  • Clinical diagnosis, based on history and physical examination
    • If unsure, see Pediatric Fever

Management
  • No specific therapy for most; self-limited
  • NSAIDS and cool liquids for pain
  • Encourage good hand hygiene to prevent spread
  • Some recommend Magic Mouthwash/oral lidocaine if not tolerating PO intake, although evidence suggests no better than placebo[1]
In infants, do NOT use oral lidocaine due to risk of lidocaine toxicity and FDA black box warning[2][3]

Disposition
  • Discharge

See Also

SGEM - Oral Lidocaine in children for mouth ulcers

References
  1. Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9
  2. FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
  3. Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39
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