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

Treatment of Hand, Foot, and Mouth Disease

The treatment for hand, foot, and mouth disease is primarily supportive and should focus on hydration and pain relief with acetaminophen or ibuprofen as needed. 1

Clinical Overview

Hand, foot, and mouth disease (HFMD) is a common viral illness primarily affecting children under 5 years of age, characterized by:

• Low-grade fever
• Painful oral ulcerations
• Maculopapular or papulovesicular rash on the hands and soles of the feet
• Self-limiting course typically resolving in 7-10 days without specific treatment 1, 2

Treatment Approach

First-Line Management

• Hydration: Ensure adequate fluid intake despite painful oral lesions
  • Offer cold liquids, popsicles, or ice cream to soothe oral pain and maintain hydration
  • Avoid acidic, spicy, or hot foods/beverages that may exacerbate pain 1

Pain Management

• Acetaminophen (paracetamol): First-line analgesic at appropriate dosing for age and weight (up to 4g daily in adults) 3, 1
• Ibuprofen: Alternative or additional analgesic if needed (up to 1.2g daily in adults) 3, 1
• Topical oral pain relief:
  • Saltwater rinses or ice chips may provide temporary relief
  • Important: Oral lidocaine is NOT recommended due to risk of numbing the gag reflex 1

What to Avoid

• Oral lidocaine preparations (risk of aspiration due to numbed gag reflex)
• No specific antiviral treatment is currently available or approved for routine HFMD 1, 2
• Antibiotics are not indicated as this is a viral infection

Special Considerations

Severe Cases

• Rare cases may develop neurologic or cardiopulmonary complications, particularly with enterovirus A71 infections 2, 4
• Intravenous immunoglobulin should be considered for severe/complicated HFMD cases as recommended by several guideline committees 2
• Hospitalization may be necessary for:
  • Inability to maintain hydration
  • Neurological complications
  • Respiratory distress

Prevention of Spread

• Handwashing is the most effective preventive measure
• Disinfection of potentially contaminated surfaces and fomites
• Isolation from school/daycare until fever resolves and mouth sores heal 1

Monitoring and Follow-up

• Most cases resolve within 7-10 days without complications
• Seek immediate medical attention if:
  • Persistent high fever
  • Neck stiffness
  • Headache
  • Lethargy or irritability
  • Respiratory distress
  • Inability to maintain hydration

Emerging Research

While no specific antivirals are currently approved, several agents are being investigated including ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline 2. An inactivated Enterovirus A71 vaccine has been approved in China and provides protection against EV-A71-related HFMD, but does not protect against other causative agents 4, 5.

Remember that while HFMD is typically mild and self-limiting, early recognition and appropriate supportive care are essential to prevent complications and reduce transmission.