Treatment of Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease (HFMD) treatment is primarily supportive, focusing on hydration and pain relief with acetaminophen or ibuprofen, as the condition is typically self-limited and resolves within 7-10 days without specific antiviral therapy. 1
Disease Overview
Hand, foot, and mouth disease is a common viral illness caused primarily by enteroviruses and coxsackieviruses. It predominantly affects children under 5 years of age but can occur in adults as well. The disease is characterized by:
- Low-grade fever
- Painful oral ulcerations
- Maculopapular or papulovesicular rash on hands and feet
- Possible buttock involvement
Treatment Approach
Pain Management
- First-line: Acetaminophen or ibuprofen for pain and fever relief 1
- Topical treatments: Consider topical NSAIDs for localized discomfort 2
- NOT recommended: Oral lidocaine (due to risk of numbing the gag reflex) 1
Oral Lesion Management
- Hydration: Encourage fluid intake; cold liquids, popsicles, and ice cream may soothe oral pain
- Soft diet: Avoid spicy, salty, acidic foods that may irritate oral lesions
- Oral hygiene: Gentle mouth rinsing with warm salt water may provide relief
Skin Lesion Care
- Local cold application: Apply crushed ice or ice cubes with water for 20 minutes with periodic interruptions to reduce discomfort 2
- Avoid harsh soaps: Use mild, non-irritating cleansers for affected areas
- Keep lesions clean and dry: Prevent secondary bacterial infection
Special Considerations
Atypical Presentations
- Children with atopic dermatitis may develop "eczema coxsackium," which can resemble herpetic superinfection 3
- Nail changes including shedding may follow HFMD after a latency period 3
Severe Cases
- Most cases are mild and self-limited
- Enterovirus 71 is associated with more severe disease and potential neurological complications, particularly in Asian outbreaks 3, 4
- Monitor for rare complications such as neurologic or cardiopulmonary involvement 1
Prevention Measures
- Handwashing: The most effective prevention method 1
- Surface disinfection: Clean potentially contaminated surfaces and fomites 1
- Isolation: Children should stay home from school/daycare until fever resolves and mouth sores heal
- Avoid close contact: Limit kissing, hugging, and sharing utensils during illness
Follow-up
- Routine follow-up is generally not required for uncomplicated cases
- Seek medical attention if:
- Symptoms worsen after 3-4 days
- Signs of dehydration develop
- Persistent high fever occurs
- Unusual drowsiness or altered mental status develops
Key Points to Remember
- HFMD is typically self-limited with symptoms resolving in 7-10 days
- No specific antiviral treatment is currently available or approved for HFMD
- Treatment focuses on symptom management and preventing dehydration
- Handwashing and proper hygiene are crucial to prevent spread
By focusing on supportive care and symptom management, most patients with HFMD will recover completely without complications.