Treatment for Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is a self-limiting viral illness that primarily requires supportive care focused on hydration and pain relief with acetaminophen or ibuprofen. 1
Disease Overview
- Caused by human enteroviruses and coxsackieviruses
- Most common in children under 10 years of age
- Characterized by:
- Low-grade fever
- Painful oral ulcerations
- Maculopapular or papulovesicular rash on hands and feet
- Typically resolves within 7-10 days without complications 1, 2
Treatment Approach
Supportive Care
Hydration management:
- Ensure adequate fluid intake
- Cold liquids, popsicles, or ice chips may soothe oral pain and prevent dehydration
- Avoid acidic, spicy, or hot foods/beverages that may irritate mouth sores 1
Pain management:
Mouth Care
- Gentle mouth rinses with warm salt water may provide relief
- Soft, bland foods are better tolerated with oral lesions 2
Skin Care
- Keep lesions clean and dry
- No specific topical treatments are required for the rash 3
Special Considerations
Severe Cases
- Intravenous immunoglobulin should be considered for severe/complicated cases (rare in North America) 2
- Monitor for neurologic or cardiopulmonary complications, which occur rarely 1
Atypical Presentations
- Children with atopic dermatitis may develop "eczema coxsackium," which can mimic herpetic superinfection 3
- Nail changes (shedding or Beau's lines) may occur weeks after initial symptoms 4, 3
Prevention Measures
- Handwashing is the most effective prevention method
- Disinfect potentially contaminated surfaces and objects
- Avoid close contact with infected individuals
- Children should stay home from school/daycare until fever subsides and mouth sores heal 1
Follow-up
- Routine follow-up is generally not required unless complications develop
- Symptoms typically resolve within 7-10 days 1, 2
Common Pitfalls
- Misdiagnosis: The differential diagnosis includes erythema multiforme, herpes, measles, and varicella 1
- Inappropriate treatment: Avoid unnecessary antibiotics as this is a viral illness
- Overlooking hydration status: Dehydration can occur due to painful oral lesions limiting fluid intake
Remember that while hand, foot, and mouth disease is typically mild and self-limiting in North America, enterovirus 71 strains common in Asia can cause more severe disease with neurological complications 2, 3.