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

Treatment for Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is primarily managed with supportive care as it is typically a self-limited viral illness that resolves within 7-10 days without specific antiviral treatment.

Clinical Presentation and Diagnosis

• HFMD is characterized by:

  • Painful oral enanthem (mouth ulcers)
  • Asymptomatic exanthem on palms and soles
  • Fever
  • Most commonly affects children under 5 years of age
  • Typically caused by coxsackievirus A16 or enterovirus A71 (EV-A71)

• Atypical presentations may include:

  • "Eczema coxsackium" in children with atopic dermatitis
  • Gianotti-Crosti-like eruptions
  • Petechial/purpuric eruptions
  • Vesiculobullous exanthema
  • Nail changes (shedding) following resolution

Treatment Approach

Supportive Care (First-line)

1. Pain and Fever Management:

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

2. Oral Care:

   • Cold fluids, popsicles, or ice cream to soothe oral pain
   • Soft, non-acidic foods
   • Avoid spicy, salty, or acidic foods that may irritate mouth sores
   • Regular oral hygiene with gentle mouthwash (saltwater rinses)

3. Hydration:

   • Ensure adequate fluid intake to prevent dehydration
   • Consider oral rehydration solutions if needed

4. Skin Care:

   • For hand and foot lesions, keep areas clean and dry
   • Topical moisturizers may help with discomfort

Management of Complications

• For Severe Cases (particularly with EV-A71):
  • Monitor for neurological complications (brainstem encephalitis, aseptic meningitis)
  • Intravenous immunoglobulin should be considered for severe/complicated HFMD 1
  • Hospitalization may be required for:
    • Neurological symptoms
    • Inability to maintain hydration
    • Respiratory distress
    • Circulatory compromise

Prevention Measures

• Good hand hygiene
• Disinfection of contaminated surfaces
• Isolation of infected individuals
• Avoid close contact (kissing, hugging, sharing utensils) with infected persons
• In high-risk areas, vaccination (where available - EV-A71 vaccine is approved in China) 2

Special Considerations

• HFMD caused by EV-A71 tends to be more severe with higher complication rates than other viral causes 1
• Nail changes may appear weeks after the initial infection 3
• Atypical presentations in children with atopic dermatitis may mimic herpetic infections 3, 4

Prognosis

Most cases resolve completely within 7-10 days without specific treatment or long-term sequelae 1, 5. However, severe cases, particularly those caused by EV-A71, may have neurological complications requiring close monitoring and supportive care.

Red Flags Requiring Urgent Medical Attention

• Persistent high fever
• Severe headache or neck stiffness
• Lethargy or altered mental status
• Respiratory distress
• Persistent vomiting
• Signs of dehydration (decreased urination, dry mouth, no tears when crying)
• Seizures or other neurological symptoms

Remember that while HFMD is typically benign, early recognition of severe cases is crucial to prevent complications and mortality, particularly in outbreaks caused by more virulent strains like EV-A71.