What is the treatment for hand foot 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 management, with no specific antiviral therapy currently recommended for routine cases.

Clinical Presentation and Diagnosis

• HFMD is a highly contagious viral illness caused by enteroviruses, most commonly coxsackieviruses A6, A10, A16, and enterovirus 71 1
• Primarily affects children under 5 years of age, but can occur in adults 2
• Typical presentation includes:
  • Low-grade fever and sore throat as initial symptoms
  • Maculopapular or papulovesicular rash on hands and soles of feet
  • Painful oral ulcerations/enanthem
  • Incubation period of 3-10 days 1
• Diagnosis is primarily clinical based on the characteristic distribution of lesions

Treatment Approach

Supportive Care (First-line)

1. Hydration management:

   • Encourage adequate fluid intake
   • Consider cold fluids, popsicles, or ice cream to soothe oral pain and maintain hydration 2
   • Avoid acidic, spicy, or hot foods/beverages that may exacerbate oral pain

2. Pain management:

   • Acetaminophen or ibuprofen as needed for pain relief and fever control 2
   • Oral lidocaine is NOT recommended 2

3. Skin care:

   • Keep lesions clean and dry
   • No specific topical treatments are required for the rash

Special Considerations

• Most cases resolve within 7-10 days without complications 2

• Rare complications may include:

  • Neurologic complications (encephalitis/meningitis)
  • Cardiopulmonary complications
  • Onychomadesis (nail shedding) occurring up to two months after initial symptoms 1

• For severe cases (rare, primarily associated with enterovirus 71):

  • Hospitalization may be required
  • Mechanical ventilation for respiratory complications
  • Intravenous immunoglobulin has been recommended by several guideline committees for severe/complicated HFMD 3

Prevention of Spread

• Handwashing is the most effective preventive measure 2
• Disinfection of potentially contaminated surfaces and fomites
• Isolation precautions during the acute phase of illness:
  • Children should stay home from school/daycare until fever resolves and mouth sores have healed
  • Avoid close contact (kissing, hugging, sharing utensils) with infected individuals

Important Clinical Pearls

• HFMD is typically benign and self-limiting in immunocompetent hosts
• No specific antiviral therapy is currently available or recommended for routine cases 2
• Enterovirus 71 is associated with more severe disease and higher complication rates than other causative viruses 3
• Outbreaks commonly occur in spring to fall in North America 2
• The disease is transmitted through fecal-oral, oral-oral, and respiratory droplet contact

While research into potential antiviral agents (ribavirin, suramin, aminothiazole analogs) is ongoing, current management remains focused on supportive care and symptom relief 3.