What is the management approach for Hand, Foot, and Mouth Disease (HFMD)?

Management of Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness that primarily requires supportive care focused on symptom management, hydration, and pain relief. 1, 2, 3, 4

Clinical Presentation and Diagnosis

• HFMD typically presents with:

  • Low-grade fever
  • Painful oral ulcerations/enanthem
  • Maculopapular or papulovesicular rash on hands and soles of feet
  • Symptoms in children under 5 years of age (most common demographic)

• Atypical presentations may include:

  • "Eczema coxsackium" in children with atopic dermatitis (resembling herpetic superinfection) 1
  • Nail changes (shedding) that may appear weeks after initial infection 1, 5

Management Approach

Supportive Care

• Hydration

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

• Pain Management

  • Acetaminophen or ibuprofen for fever and pain relief 4
  • Dosing based on weight and age per standard pediatric guidelines
  • Oral lidocaine is NOT recommended 4

• Oral Care

  • Gentle mouth rinses with warm salt water
  • Soft diet to minimize discomfort from oral lesions

When to Consider Additional Interventions

• Most cases resolve within 7-10 days without sequelae 1, 4
• Seek medical attention for:
  • Signs of dehydration (decreased urine output, dry mucous membranes)
  • Persistent high fever
  • Neurological symptoms (headache, neck stiffness, altered mental status)
  • Respiratory distress

Special Considerations

• Enterovirus A71 (EV-A71) can cause more severe disease with neurological and cardiopulmonary complications 2, 3
• Intravenous immunoglobulin should be considered for severe/complicated cases 2
• Currently, no specific antiviral agents are approved for HFMD treatment 2, 3

Prevention

• Handwashing is the most effective prevention method 4

• Disinfection of potentially contaminated surfaces and fomites

• Isolation of infected individuals, particularly from:

  • Schools
  • Daycare centers
  • Other settings with vulnerable populations

• In high-risk areas (particularly Asia), EV-A71 vaccination may be available 3

Follow-up

• Routine follow-up is not necessary for uncomplicated cases
• Parents should be educated about:
  • Expected disease course (7-10 days)
  • Potential for nail changes weeks after resolution
  • When to seek medical attention for complications

Key Pitfalls to Avoid

1. Misdiagnosing atypical presentations, especially in children with atopic dermatitis
2. Using oral lidocaine, which is not recommended
3. Failing to recognize signs of severe disease requiring hospitalization (particularly with EV-A71)
4. Unnecessary antibiotic use, as HFMD is viral in etiology
5. Inadequate attention to hydration status, especially in young children with painful oral lesions

Remember that while HFMD is typically mild and self-limited, early recognition of severe cases is essential to prevent complications and mortality, particularly in outbreaks caused by more virulent strains.