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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limiting viral illness that primarily requires supportive care focused on symptom relief, with no specific antiviral therapy recommended for routine cases.

Disease Overview

Hand, foot, and mouth disease is a highly contagious viral illness primarily affecting children under 10 years of age, though adults can also be affected. It is caused by various enteroviruses, most commonly:

• Coxsackievirus A16
• Enterovirus 71 (associated with more severe cases)
• Coxsackievirus A6 (increasingly common in recent outbreaks)
• Coxsackievirus A10

The disease is characterized by:

• Low-grade fever
• Painful oral ulcerations/enanthem
• Maculopapular or papulovesicular rash on hands and feet
• Typical incubation period of 3-10 days
• Self-limiting course with resolution in 7-10 days

Treatment Approach

Supportive Care (First-Line Management)

• Hydration: Ensure adequate fluid intake, especially important due to painful oral lesions that may limit intake 1
• Pain management: Acetaminophen or ibuprofen as needed for pain and fever 1
• Oral care: Soft, cold foods and beverages that don't irritate mouth ulcers

What to Avoid

• Oral lidocaine is not recommended for pain management 1
• Routine antibiotics are not indicated as this is a viral infection
• No specific antiviral therapy is available or recommended for routine cases 2, 1

Special Considerations

Severe Cases

In rare instances, HFMD can lead to severe complications, particularly with EV71 infections:

• Neurological complications (encephalitis, meningitis)
• Cardiopulmonary complications (pulmonary edema)
• Acute flaccid paralysis

For severe/complicated cases:

• Intravenous immunoglobulin (IVIG) should be considered and has been recommended by several national guidelines 3, 4
• Mechanical ventilation may be required for respiratory complications
• Hospital admission for monitoring and supportive care

Atypical Presentations

• Recent outbreaks caused by coxsackievirus A6 have shown more severe symptoms than "classical" HFMD 2
• Onychomadesis (nail shedding) may occur 1-2 months after initial symptoms, particularly with coxsackievirus A6 infections 2

Prevention Measures

• Handwashing is the most effective preventive measure 1
• Surface disinfection of potentially contaminated surfaces and fomites 1
• Avoid close contact with infected individuals
• In high-risk areas, vaccination (available in mainland China against EV71) 5

Clinical Course and Follow-up

Most cases resolve completely within 7-10 days without specific treatment or sequelae 3. Patients and caregivers should be advised that:

• The disease is highly contagious during the first week
• Children should stay home from school/daycare until fever resolves and mouth sores heal
• Hand hygiene is critical to prevent spread to other family members

Common Pitfalls to Avoid

• Overtreatment with unnecessary antibiotics
• Failure to ensure adequate hydration, especially in young children
• Misdiagnosis - consider differential diagnoses including erythema multiforme, herpes, measles, and varicella 1
• Failure to recognize severe cases requiring hospitalization (particularly EV71 infections)

By focusing on supportive care and symptom management, most cases of hand, foot, and mouth disease will resolve without complications.