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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness that requires only supportive care focused on hydration and pain relief with acetaminophen or ibuprofen as needed.

Disease Overview

• HFMD is caused by human enteroviruses and coxsackieviruses, most commonly affecting children under 10 years of age 1
• Characterized by low-grade fever, painful oral ulcerations, and maculopapular or papulovesicular rash on hands and soles of feet
• Typically resolves within 7-10 days without specific treatment 1, 2
• Transmission occurs through fecal-oral, oral-oral, and respiratory droplet contact

Treatment Approach

First-Line Management

• Supportive care is the mainstay of treatment 1, 2:
  • Ensure adequate hydration (most important)
  • Pain relief with acetaminophen or ibuprofen as needed
  • Cold, soft foods and drinks to soothe oral pain
  • Avoid spicy, salty, or acidic foods that may irritate oral lesions

What NOT to Use

• Oral lidocaine is not recommended 1
• No specific antiviral treatment is currently approved or available 1, 2
• Systemic corticosteroids are not indicated and should be avoided

Management of Severe Cases

• While most cases are mild and self-limiting, severe cases (particularly those caused by enterovirus A71) may require:
  • Hospitalization for supportive care in patients with neurologic symptoms, inability to maintain hydration, or systemic complications 2, 3
  • Intravenous immunoglobulin may be considered for severe/complicated HFMD according to some guidelines 2

Prevention Measures

• Handwashing is the most effective preventive measure 1
• Disinfection of potentially contaminated surfaces and fomites
• Isolation of infected individuals, particularly from schools or daycare centers until fever subsides and lesions heal
• Good personal hygiene practices

Special Considerations

• Atypical presentations may occur in patients with atopic dermatitis ("eczema coxsackium") 4
• Nail changes (shedding) may follow HFMD after a latency period 4
• Adults can be affected, though less commonly than children, and may experience more severe symptoms 3

Follow-up

• Routine follow-up is generally unnecessary unless complications develop
• Parents/patients should be advised to seek medical attention if:
  • Signs of dehydration develop
  • Fever persists beyond 3-4 days
  • Neurological symptoms occur (headache, irritability, altered mental status)

Remember that HFMD is almost always a self-limited disease with excellent prognosis. The focus should be on symptom management and preventing spread to others through good hygiene practices.