Respiratory droplet transmission may also occur, but is less certain. Complications are rare, but as with any pruritic rash, a secondary skin infection may occur. Enteroviruses as a group are a cause of aseptic meningitis. However, HFM disease is usually not associated with meningitis. Males and females are affected equally.
Males are more likely to become symptomatically ill.
Yellow ulcers surrounded by red halos characterize the oral lesions. These occur primarily on the labial and buccal mucosal surfaces, but they may be seen on the tongue, palate, uvula, anterior tonsillar pillars or gums. The oral ulcers are usually only mildly painful. Children under 5 y predominately are more symptomatic. The exanthem involves the palmar, plantar and interdigital surfaces of the hands and feet.