Treatment for Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is a self-limited viral illness that requires only supportive care focused on hydration and pain relief with acetaminophen or ibuprofen. 1
Disease Overview
Hand, foot, and mouth disease (HFMD) is a common viral illness primarily affecting children under 5 years of age, caused by human enteroviruses and coxsackieviruses. The disease is characterized by:
- Low-grade fever
- Painful oral ulcerations/enanthem
- Maculopapular or papulovesicular rash on hands and soles of feet
- Typical duration of 7-10 days with spontaneous resolution 1, 2
Treatment Approach
First-Line Management (Supportive Care)
Hydration: Ensure adequate fluid intake despite painful oral lesions
- Offer cold fluids, popsicles, or ice cream to soothe oral discomfort
- Avoid acidic, salty, or spicy foods that may exacerbate pain 1
Pain management:
- Acetaminophen or ibuprofen as needed for pain and fever control
- Important note: Oral lidocaine is NOT recommended 1
What NOT to Do
- No antiviral treatments are currently available or approved for HFMD 1, 2
- Avoid oral lidocaine preparations due to risk of numbing the gag reflex 1
- No role for antibiotics as this is a viral infection
Special Considerations
Monitoring for Complications
While most cases resolve without sequelae, monitor for rare but serious complications:
- Neurological complications (particularly with EV-A71 strain)
- Cardiopulmonary complications
- Nail changes (dystrophies, shedding) may occur weeks after initial infection 3, 4
Severe Cases
In rare severe cases, particularly those caused by Enterovirus A71:
- Hospitalization may be required for supportive care
- Intravenous immunoglobulin should be considered for severe/complicated HFMD 2
Prevention Measures
- Hand hygiene: Thorough handwashing is the most effective prevention method
- Environmental cleaning: Disinfect potentially contaminated surfaces and fomites
- Isolation: Children should stay home from school/daycare until fever resolves and mouth sores heal
- Avoid close contact: No kissing, hugging, or sharing utensils with infected individuals 1, 4
Expected Course and Follow-up
- Most patients recover completely within 7-10 days without specific treatment
- No routine follow-up is necessary for uncomplicated cases
- Parents should seek medical attention if:
The evidence clearly shows that HFMD is typically a benign, self-limited condition that requires only supportive care. While research on potential antivirals is ongoing, the current standard of care remains focused on symptom management and prevention of spread.