What is the treatment for hand, foot, and mouth disease?

Treatment of Hand, Foot, and Mouth Disease

The treatment for hand, foot, and mouth disease is primarily supportive care focused on hydration and pain relief with acetaminophen or ibuprofen as needed. 1

Clinical Presentation

Hand, foot, and mouth disease (HFMD) is a common viral illness characterized by:

• Low-grade fever
• Painful oral ulcerations/enanthem
• Maculopapular or papulovesicular rash on hands and soles of feet
• Primarily affects children under 10 years of age
• Self-limited disease typically resolving in 7-10 days without sequelae

Causative Agents and Transmission

• Caused by human enteroviruses and coxsackieviruses (most commonly Coxsackievirus A16 and Enterovirus A71)
• Transmitted through:
  • Fecal-oral contact
  • Oral-oral contact
  • Respiratory droplets
• Outbreaks commonly occur in spring to fall in North America

Treatment Approach

Supportive Care (First-Line)

• Hydration: Ensure adequate fluid intake, especially important with painful oral lesions
• Pain management:
  • Acetaminophen (first-line) at appropriate pediatric dosing
  • Ibuprofen (alternative) at appropriate pediatric dosing
  • Note: Oral lidocaine is NOT recommended 1

Symptomatic Relief for Oral Lesions

• Cold fluids, popsicles, or ice chips to soothe oral pain
• Soft, non-acidic foods and cold milk products
• Avoid spicy, salty, acidic foods and carbonated beverages that may irritate oral lesions

Management of Skin Lesions

• Keep lesions clean and dry
• No specific topical treatments are required for the skin manifestations

Important Considerations

When to Seek Medical Attention

• Signs of dehydration (decreased urination, dry mouth, lethargy)
• Persistent high fever (>101°F or 38.3°C for >3 days)
• Severe headache, neck stiffness, or altered mental status (rare neurologic complications)
• Difficulty breathing or rapid breathing (rare cardiopulmonary complications)

Prevention Measures

• Handwashing is the most effective preventive measure
• Disinfection of potentially contaminated surfaces and fomites
• Avoiding close contact with infected individuals
• Proper disposal of soiled items (tissues, diapers)

Special Situations

Atypical Presentations

• "Eczema coxsackium" may occur in children with atopic dermatitis, resembling herpetic infection 2
• Nail changes including shedding may follow HFMD after a latency period 2
• Enterovirus A71 infections may cause more severe disease with higher risk of complications 3

Severe Cases

• Intravenous immunoglobulin may be considered for severe/complicated HFMD, particularly with neurological involvement 3
• Currently, no specific antiviral agents are approved for HFMD treatment 3

Prognosis

• Most cases resolve completely within 7-10 days
• Complications are rare but can include neurologic or cardiopulmonary issues in severe cases
• Mortality is very low in developed countries but can be higher in some regions with Enterovirus A71 outbreaks

Remember that HFMD is highly contagious, and infected individuals should avoid close contact with others, particularly pregnant women and young children, until symptoms resolve.