Chickenpox vs. Hand, Foot, and Mouth Disease: How to Tell the Difference (With Pictures)

Chickenpox (varicella) and hand, foot, and mouth disease (HFMD) are two contagious viruses that can cause fever, sores in the mouth, and blisters on the skin. While these illnesses can appear similar, they can have different complications. Knowing how to tell them apart is important. Here, we'll compare these two viruses, including how the symptoms and rashes develop.

Hand, foot, and mouth disease

Hand, foot, and mouth disease (HFMD) is a contagious viral infection that usually affects children younger than 5 years. Several different viruses can cause HFMD, but coxsackievirus A16 and enterovirus A71 are the most common ones. All the viruses that cause HFMD are very contagious and spread through contact with:

• Respiratory droplets (like from a sneeze or cough)

• Contaminated objects (like toys or a door handle)

• Fluid from the skin blisters

• Poop (like when changing a diaper)

Symptoms of hand, foot, and mouth disease

Most people with HFMD have mild symptoms over 7 to 10 days and then recover. The first symptoms usually include:

• Low-grade fever

• Runny nose

• Decreased appetite

• Tiredness

• Sore throat or mouth pain

Rash from hand, foot, and mouth disease

After the initial symptoms, a characteristic rash appears, forming sores and blisters in the mouth and on the skin. Here's how the rash typically develops:

• Painful blisters and sores form in the mouth, on the tongue, inside the cheeks, and on the roof of the mouth.

• Small round spots, bumps, and blisters appear most commonly on the palms, soles, and around the mouth. They can also be on the buttocks, knees, and elbows. The spots can be pink (in fair skin) or violet and skin-colored (in darker skin).

• Blisters on the skin eventually rupture and form crusts before healing.

Complications from hand, foot, and mouth disease

Most people recover from HFMD without any problems. In rare situations, more serious complications can occur, like:

• Pneumonia

• Heart inflammation (myocarditis)

• Fluid in the lungs

• Meningitis

• Acute flaccid paralysis

Pictures of hand, foot, and mouth disease

These pictures of the rash caused by hand, foot, and mouth disease can help you know what it looks like, and how it presents in different parts of the body and various skin tones.

Chickenpox

Chickenpox, also called varicella, is an infection caused by the varicella-zoster virus. It's highly contagious, and can spread through contact with:

• Respiratory droplets, like from a cough or sneeze

• Contaminated objects, like clothing

• Saliva

• Fluid from the skin blisters

You can prevent chickenpox with a vaccine, which you usually get as a series of two doses during childhood. But, adults can get the vaccine, too, if they've never been vaccinated or had chickenpox before.

Chickenpox symptoms

The first symptoms of chickenpox can include a low-grade fever and feeling tired or weak. Other symptoms may include:

• Achy muscles

• Decreased appetite

• Nausea

• Headache

In adolescents and adults, the chickenpox rash usually appears soon after the initial symptoms. But in children, the rash may be the initial sign of chickenpox.

Chickenpox rash

In some people, the first signs of the chickenpox rash are small, painful, and itchy sores in the mouth. The rash will then typically develop on the skin in this way:

• Small, red, violet, or brown dots appear on the face, scalp, trunk, and upper arms and legs.

• Over 10 to 12 hours, these spots develop into small bumps, clear blisters, and then pus-filled bumps (called pustules).

• The rash becomes very itchy once blisters form.

• Eventually, the pus bumps break open and crust over.

People can have hundreds of spots on their body at once. It's also common for the spots to crop up at different times over the course of several days. So you can have spots in different stages (for example, flat dots and pus bumps at the same time).

Chickenpox complications

In general, healthy people will recover from chickenpox without any problems. People who are pregnant or who have a weakened immune system are at risk of developing health complications, including:

• Dehydration

• Pneumonia

• Brain swelling (encephalitis)

• Bleeding problems

• Bacterial infections in the skin

If you've had chickenpox, you may also develop shingles in the future. They're both caused by the same virus. Once chickenpox heals, the virus stays inactive in your nervous system for years. At some point (like with stress) it can reactivate and cause a painful shingles rash. The shingles vaccine can help prevent this outbreak from happening.

Pictures of chickenpox

Here are some pictures of the chickenpox rash to help you know what it looks like at different stages.

Comparing chickenpox and hand, foot, and mouth disease

This chart summarizes some of the differences and similarities between these two viruses.

Treating chickenpox and HFMD

Treating both viruses involves hydration, rest, and treating a fever or pain with acetaminophen or ibuprofen.

For chickenpox, antiviral medication (like acyclovir) is also available. This is recommended in people who are more likely to develop a more serious illness, like people who are pregnant or have a weakened immune system.

Frequently asked questions

Images used with permission from VisualDx (www.visualdx.com).