Na chorobę dłoni, stóp i jamy ustnej najczęściej zapadają niemowlęta i dzieci przed 5. rokiem życia. Oprócz objawów takich jak gorączka i ból gardła schorzenie to wywołuje charakterystyczne zmiany skórne, których niewłaściwe leczenie może doprowadzić do nadkażeń bakteryjnych.
HFMS (ang. Hand, Foot, and Mouth Syndrome – HFMS) potocznie nazywa się bostonką lub chorobą bostońską. Schorzenie to wywołują enterowirusy, najczęściej wirusy z gatunku Coxsackie. Chociaż HFMS uznaje się za chorobę wieku dziecięcego, może dotknąć także osoby dorosłe. Do zakażenia dochodzi drogą kropelkową i w wyniku bezpośredniego kontaktu z wydzielinami albo wydalinami. Ryzyko zarażenia jest szczególnie duże wśród skupisk dzieci, takich jak przedszkola czy żłobki, ze względu na trudność utrzymania w takich miejscach higieny.
Jak przebiega HFMS?
Okres wylęgania HFMS trwa od 3 do 5 dni. Zwykle chorzy przechodzą go bezobjawowo. Najwcześniejszymi symptomami tej choroby są ból gardła, brak apetytu i pogorszenie samopoczucia. Mogą również wystąpić mdłości i biegunka. Następnie pojawia się sięgająca do 39-st. ⁰C gorączka, która znika po upływie 48 godzin. U chorego oprócz bólu gardła występują także charakterystyczne zmiany skórne. Terapia HFMS opiera się na łagodzeniu dolegliwości – objawy w większości przypadków ustępują samoistnie w ciągu 7-10 dni.
Zmiany skórne w HFMS – jak je rozpoznać?
W śluzówce jamy ustnej pacjenta można zauważyć pęcherzyki o czerwonej obwódce, często wypełnione płynem o przezroczystym lub mlecznym zabarwieniu. Pękające pęcherzyki skutkują utworzeniem się nadżerek, czyli płytkich owrzodzeń. W dalszym przebiegu choroby może dojść do herpanginy – ostrego zapalenia gardła. Pacjent doświadcza silnego bólu podczas przełykania śliny oraz przyjmowania płynów i pokarmów.
Wysypka w formie płaskich czerwonych plam pojawia się także na dłoniach i podeszwach stóp. Rzadziej obejmuje łokcie, kolana, pośladki i okolice narządów rodnych. Czerwonym plamom mogą towarzyszyć szare pęcherze o wielkości 3-7 mm. Po pęknięciu przyjmują postać bolesnych owrzodzeń. Choremu może dokuczać uporczywy świąd.
Po ustąpieniu zmian często dochodzi do łuszczenia skóry. Po około 1,5 miesiąca od wyleczenia na płytkach paznokciowych można dostrzec białe bruzdy. Płytki mogą się także rozwarstwiać.
Jak postępować w przypadku zmian skórnych?
By zmniejszyć bolesność jamy ustnej, zaleca się picie schłodzonej wody. Nie powinno się podawać choremu kwaśnych płynów i pokarmów. Ból spowodowany nadżerkami można łagodzić także ziołowymi płukankami, m.in. z szałwii, rumianku czy kwiatu czarnego bzu.
Pęcherze osusza się płynami i środkami antywirusowymi. Rozdrapywanie czy próby wyciskania treści pęcherzy mogą skutkować zakażeniem. Świąd i pieczenie można łagodzić lekami przeciwhistaminowymi. Na wysypkę nie należy stosować pudrów, ponieważ sprzyjają rozwojowi bakterii, co może prowadzić do wtórnych nadkażeń. W przypadku ich wystąpienia lekarz może zapisać antybiotyki miejscowe lub doustne.
HFMS a ospa wietrzna – jak odróżnić?
W przypadku ospy wietrznej wysypka pojawia się na całym ciele, natomiast w HFMS zmiany skórne występują tylko na niektórych partiach ciała – w jamie ustnej, na dłoniach i podeszwach stóp.
Choroba dłoni, stóp i jamy ustnej często mylona jest również z rumieniem wielopostaciowym wysiękowym. W przypadku rumienia zmiany skórne są symetryczne i kształtem przypominają koncentryczne figury.
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Przeczytaj także: Opryszczkowe zapalenie jamy ustnej. Jak objawia się u dzieci?
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