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

Management of Hand, Foot, and Mouth Disease

The management of hand, foot, and mouth disease (HFMD) is primarily supportive, focusing on adequate hydration and pain relief with acetaminophen or ibuprofen as needed. 1

Clinical Presentation

• HFMD typically presents with:
  • Low-grade fever
  • Painful oral ulcerations/enanthem
  • Maculopapular or papulovesicular rash on hands and soles of feet
  • Symptoms usually resolve within 7-10 days without specific treatment 1, 2

Supportive Care Measures

Hydration

• Ensure adequate fluid intake to prevent dehydration
• Cold liquids, popsicles, or ice cream may be soothing and encourage fluid intake
• Avoid acidic, spicy, or hot foods/beverages that may irritate oral lesions

Pain Management

• Acetaminophen or ibuprofen for fever and pain relief 1
• Important: Oral lidocaine is NOT recommended 1
• For oral lesions:
  • Salt water rinses (for older children who can rinse and spit)
  • Cold foods/beverages to numb oral pain

Skin Care

• Keep lesions clean and dry
• No specific topical treatments are required for skin lesions
• For itchy lesions, cool baths may provide relief

Special Considerations

Severe Cases

• Monitor for rare neurologic or cardiopulmonary complications 1, 3
• Signs requiring immediate medical attention:
  • Persistent high fever
  • Lethargy or altered mental status
  • Severe headache
  • Respiratory distress
  • Rapid heart rate

Atypical Presentations

• Children with atopic dermatitis may develop "eczema coxsackium" - more extensive rash in areas of eczema that may resemble herpetic infection 2
• Nail changes (shedding or Beau's lines) may occur weeks after initial infection 4

Prevention Measures

• Handwashing is the most effective preventive measure 1
• Disinfect potentially contaminated surfaces and fomites
• Avoid close contact with infected individuals
• Children should stay home from school/daycare until:
  • Fever resolves
  • Mouth sores heal
  • Drooling from mouth sores stops

Important Caveats

• No specific antiviral treatment is currently available 1, 5
• Enterovirus 71 strains (common in Asia) can cause more severe disease with neurological complications 2, 3
• The disease is highly contagious, transmitted via:
  • Fecal-oral contact
  • Oral-oral contact
  • Respiratory droplets 1

Follow-up

• Most cases resolve without complications and do not require follow-up
• Return for medical evaluation if:
  • Symptoms worsen
  • Signs of dehydration develop
  • Neurological symptoms occur
  • Fever persists beyond 3-4 days

By focusing on supportive care with adequate hydration and appropriate pain management, most cases of HFMD will resolve without complications within 7-10 days.