What is the best advice for managing hand, foot, and mouth disease?

Management of Hand, Foot, and Mouth Disease

The best advice for managing hand, foot, and mouth disease is to focus on supportive care including adequate hydration, pain management with acetaminophen or ibuprofen, and proper hand hygiene to prevent transmission, as the disease is typically self-limiting and resolves within 7-10 days without specific antiviral treatment. 1

Disease Overview

Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness primarily affecting children under 5 years of age, though it can occasionally affect adults. It is caused by enteroviruses, most commonly coxsackieviruses A6, A10, A16, and enterovirus 71 2, 1.

Clinical Presentation

• Low-grade fever
• Painful oral ulcerations/enanthem
• Maculopapular or papulovesicular rash on hands and soles of feet
• Symptoms typically appear after an incubation period of 3-10 days 2

Management Approach

1. Supportive Care

• Hydration: Ensure adequate fluid intake despite painful oral lesions
• Pain management: Use acetaminophen or ibuprofen as needed for pain and fever 1
• Avoid: Oral lidocaine is not recommended 1

2. Infection Control Measures

• Hand hygiene: Perform thorough handwashing with soap and water, especially after contact with infected individuals 3, 1
  • When hands are visibly soiled, use soap and water
  • If hands are not visibly soiled, alcohol-based hand rubs are acceptable 3
• Surface disinfection: Clean potentially contaminated surfaces and objects 1
• Isolation: Keep infected individuals away from school, daycare, or work until fever subsides and lesions heal

Special Considerations

Severe Cases

• While most cases are mild and self-limiting, severe complications can occur, particularly with enterovirus 71 infections 2, 4
• Warning signs requiring medical attention:
  • Persistent high fever
  • Neurological symptoms (headache, irritability, lethargy)
  • Respiratory distress
  • Dehydration due to difficulty swallowing

Potential Complications

• Rare but serious complications include:
  • Neurological complications (encephalitis, meningitis)
  • Cardiopulmonary complications
  • Nail dystrophies (e.g., nail shedding) occurring weeks after initial symptoms 5, 6

Prevention Strategies

• Hand hygiene: Regular handwashing for at least 15 seconds with soap and water 3
• Avoid close contact: Minimize contact with infected individuals
• Environmental cleaning: Disinfect commonly touched surfaces
• Avoid sharing: Do not share utensils, cups, or personal items with infected individuals

Important Caveats

• No specific antiviral treatment is currently available for routine HFMD 1, 4
• Antibiotics are not effective as this is a viral infection
• The disease is highly contagious during the first week of illness
• Multiple strains can circulate simultaneously, making prevention challenging 6
• Recovery typically occurs within 7-10 days without specific treatment 1, 4

HFMD should not be confused with similar-appearing conditions such as erythema multiforme, herpes, measles, or varicella, which may require different management approaches 1.