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

Treatment of Hand, Foot, and Mouth Disease

The treatment for hand, foot, and mouth disease (HFMD) is primarily symptomatic and supportive care, as the disease is typically self-limited and resolves within 7-10 days without specific antiviral therapy.

Causative Agents and Clinical Presentation

• HFMD is most commonly caused by Coxsackievirus A16 (CV-A16) and Enterovirus 71 (EV71), with Coxsackievirus A6 (CV-A6) emerging as an increasingly important causative agent 1, 2
• Primarily affects children under 5 years of age, though adults can be affected, especially with CV-A6 2, 3
• Characterized by:
  • Painful oral enanthem (mouth sores)
  • Skin rash on palms and soles
  • Fever (≥38°C)
  • In severe cases: neurological symptoms, respiratory distress, and cardiovascular complications 4

Treatment Approach

1. Symptomatic Relief

• Pain management:

  • Acetaminophen or ibuprofen for fever and pain relief
  • Avoid aspirin in children due to risk of Reye syndrome

• Oral lesion management:

  • Cold foods (popsicles, ice cream) to soothe oral pain
  • Soft, non-acidic foods and cold liquids
  • Avoid spicy, salty, acidic foods that may irritate mouth sores

• Skin lesion care:

  • Keep lesions clean and dry
  • Gentle skin care with mild, non-irritating cleansers

2. Hydration

• Ensure adequate fluid intake to prevent dehydration
• Small, frequent sips of water or electrolyte solutions if oral pain makes drinking difficult
• In severe cases with inability to maintain hydration, IV fluids may be necessary

3. Management of Severe Cases

For patients with severe HFMD (particularly with EV71 infection) showing neurological or cardiorespiratory involvement:

• Hospitalization for close monitoring
• Intravenous immunoglobulin (IVIG) should be considered for severe/complicated cases 2
• Mechanical ventilation if respiratory compromise occurs 4
• Supportive care for neurological and cardiovascular complications

Special Considerations

Atypical Presentations

• CV-A6 infections may present with more severe and widespread rash, higher fever, and longer disease duration 3
• "Eczema coxsackium" can occur in children with atopic dermatitis, resembling herpetic superinfection 5
• Nail changes (shedding) may follow HFMD after a latency period 5

Prevention Measures

• Good hand hygiene (frequent handwashing)
• Disinfection of contaminated surfaces
• Avoiding close contact with infected individuals
• Exclusion from school/daycare until fever resolves and mouth sores heal

Monitoring and Follow-up

• Most cases resolve without complications within 7-10 days
• Monitor for rare complications:
  • Neurological: encephalitis, aseptic meningitis, acute flaccid paralysis
  • Cardiopulmonary: myocarditis, pulmonary edema
  • Dehydration due to poor oral intake

Research Developments

• Potential antiviral agents under investigation include ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline 2
• Vaccine development is underway, particularly targeting EV71 in regions with epidemic outbreaks 2, 5

The cornerstone of HFMD management remains supportive care focused on symptom relief, adequate hydration, and monitoring for complications, with special attention to severe cases that may require hospitalization and additional interventions.