Treatment for Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease (HFMD) is a self-limiting viral illness that requires supportive care focused on hydration and pain relief with acetaminophen or ibuprofen as the primary treatment approach.
Disease Overview
- Caused by human enteroviruses and coxsackieviruses
- Most common in children under 5 years of age
- Transmitted through fecal-oral, oral-oral, and respiratory droplet contact
- Characterized by:
- Low-grade fever
- Painful oral ulcerations
- Maculopapular or papulovesicular rash on hands and feet
- Typically resolves in 7-10 days without sequelae 1, 2
Treatment Approach
Supportive Care (First-line)
- Maintain adequate hydration
- Offer cold fluids frequently
- Avoid acidic or spicy foods/drinks that may irritate mouth sores
- Pain management:
- Acetaminophen (first choice) for pain and fever
- Ibuprofen as an alternative analgesic 1
Important Cautions
- Oral lidocaine is NOT recommended due to risk of numbing the gag reflex
- No specific antiviral treatment is currently approved for HFMD
- Antibiotics have no role in treatment as this is a viral infection 1, 2
Management of Severe Cases
- Most cases are mild and can be treated as outpatients
- Hospital admission criteria:
- Persistent high fever
- Neurological involvement
- Respiratory distress
- Circulatory dysfunction
- Elevated peripheral WBC count
- Elevated blood glucose
- Elevated blood lactic acid 3
Special Considerations
- Children under 3 years with EV-A71 infection require closer monitoring
- Early recognition of disease progression is critical to prevent complications
- Intravenous immunoglobulin should be considered for severe/complicated cases 2, 3
Prevention Strategies
- Handwashing is the most effective preventive measure
- Disinfection of potentially contaminated surfaces and objects
- Isolation of infected individuals to prevent spread
- Good personal hygiene practices 1, 4
Complications to Monitor
- Rare but serious complications include:
While vaccines against EV-A71 have been developed and approved in China, they are not widely available globally and only protect against one causative agent of HFMD 4, 5.