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

Treatment of Hand, Foot, and Mouth Disease (HFMD)

Treatment for hand, foot, and mouth disease is primarily supportive, focusing on symptom management with acetaminophen or ibuprofen for fever and pain relief, and ensuring adequate hydration, as the disease is typically self-limiting and resolves within 7-10 days. 1

Disease Overview

Hand, foot, and mouth disease is a highly contagious viral illness caused by enteroviruses, most commonly coxsackieviruses (particularly A6, A10, A16) and enterovirus 71. It primarily affects children under 10 years of age but can occasionally affect adults. The disease is characterized by:

• Low-grade fever
• Painful oral ulcerations
• Maculopapular or papulovesicular rash on hands and soles of feet
• Transmission via fecal-oral, oral-oral, and respiratory droplet contact

Treatment Approach

Symptom Management

• Pain and fever control:

  • Acetaminophen or ibuprofen as needed for pain and fever 1
  • Avoid oral lidocaine as it is not recommended for HFMD 1

• Oral lesion management:

  • For painful mouth ulcers, consider steroid mouthwash for symptom relief (similar to management principles for stomatitis) 2
  • Mild toothpaste and gentle oral hygiene 2

• Hydration:

  • Ensure adequate fluid intake, especially when oral ulcers make eating and drinking painful
  • Cold liquids, popsicles, or ice cream may be soothing and encourage fluid intake

Important Considerations

• No specific antiviral therapy is available or recommended for routine HFMD cases 1, 3
• Antibiotics are not indicated as HFMD is viral in nature
• Most cases resolve spontaneously within 7-10 days without complications 1

Special Situations

Severe Cases

While rare in North America and Europe, severe complications can occur, particularly with enterovirus 71 infections:

• Neurological complications (encephalitis, meningitis)
• Cardiopulmonary complications (pulmonary edema)
• In these cases, hospitalization and supportive care may be necessary 3, 4

Atypical Presentations

Recent outbreaks of coxsackievirus A6 have been associated with:

• More severe skin manifestations
• Atypical rash distribution
• Onychomadesis (nail shedding) occurring up to two months after initial symptoms 3, 5

Prevention Strategies

• Hand hygiene: Thorough handwashing, especially after diaper changes and before handling food 1
• Environmental cleaning: Disinfection of potentially contaminated surfaces and fomites 1
• Isolation: Children should stay home from school or daycare until fever resolves and mouth sores heal
• No vaccine is currently available for widespread use 4

Common Pitfalls to Avoid

• Misdiagnosis: HFMD can be confused with other conditions like erythema multiforme, herpes, measles, and varicella 1
• Overtreatment: Avoid unnecessary antibiotics as they have no effect on viral infections
• Inadequate pain control: Painful oral lesions can lead to dehydration if pain is not adequately managed

Follow-up

• Most cases do not require specific follow-up unless complications develop
• Parents should be advised to seek medical attention if:
  • Fever persists beyond 3-4 days
  • Child shows signs of dehydration
  • Unusual drowsiness or severe headache develops (potential neurological complications)
  • Symptoms worsen or fail to improve after 7-10 days

By focusing on supportive care and symptom management, most children with HFMD will recover completely without complications.