What is the recommended treatment for hand, foot, and mouth disease (HFMD)?

Management of Hand, Foot, and Mouth Disease

Treatment for hand, foot, and mouth disease (HFMD) is primarily supportive, focusing on hydration and pain relief with acetaminophen or ibuprofen as needed. 1

Disease Overview

Hand, foot, and mouth disease is a common viral illness primarily affecting children under 5 years of age, characterized by:

• Low-grade fever
• Painful oral ulcerations
• Maculopapular or papulovesicular rash on hands and soles of feet
• Typically self-limiting, resolving in 7-10 days without complications 1, 2

Recommended Treatment Approach

First-Line Management

• Hydration

  • Encourage adequate fluid intake
  • Cold liquids, popsicles, or ice cream may soothe mouth pain and prevent dehydration

• Pain and Fever Control

  • Acetaminophen or ibuprofen as needed for pain relief and fever reduction
  • Dose appropriately based on patient's age and weight

• Oral Care

  • Rinse mouth with warm salt water
  • Avoid spicy, acidic, or hot foods and beverages that may irritate oral lesions

What NOT to Use

• Oral lidocaine is not recommended 1
• No specific antiviral treatment is currently available or approved for HFMD 1, 3

Special Considerations

For Severe Cases

• Most cases are mild and self-limiting
• Rare complications may include:
  • Neurologic complications
  • Cardiopulmonary complications 1, 2
• Intravenous immunoglobulin should be considered for severe/complicated cases 3

Prevention Strategies

• Handwashing is the most effective preventive measure
• Disinfect potentially contaminated surfaces and fomites
• Avoid close contact with infected individuals
• Good personal hygiene practices 1

When to Seek Medical Attention

• Signs of dehydration (dry mouth, decreased urination, lethargy)
• Persistent high fever
• Unusual drowsiness or confusion
• Severe headache or stiff neck
• Symptoms not improving after 7-10 days

Common Pitfalls to Avoid

1. Misdiagnosis: The differential diagnosis for childhood rashes and oral lesions is broad and includes erythema multiforme, herpes, measles, and varicella 1

2. Underestimating contagiousness: HFMD is highly contagious and can be transmitted through:

   • Fecal-oral contact
   • Oral-oral contact
   • Respiratory droplets 1, 2

3. Overlooking atypical presentations: Recognizing atypical manifestations is crucial for correct diagnosis and appropriate treatment 3

4. Inadequate isolation: Children should be kept home from school or daycare until fever subsides and mouth sores heal to prevent spread

While there are ongoing investigations into potential antiviral treatments such as ribavirin, suramin, and other compounds, none are currently approved for clinical use in HFMD 3. The cornerstone of management remains supportive care with a focus on symptom relief and adequate hydration.