What is the treatment for hand, foot, and mouth disease (HFMD)?

Treatment of Hand, Foot, and Mouth Disease

The treatment of hand, foot, and mouth disease (HFMD) is primarily symptomatic and supportive, as the condition is typically self-limited and resolves within 7-10 days without specific antiviral therapy. 1

Clinical Overview

Hand, foot, and mouth disease is a common viral illness primarily affecting children under 5 years of age. It is characterized by:

• Painful oral enanthem (mouth sores)
• Asymptomatic exanthem on palms and soles
• Low-grade fever
• Possible irritability and decreased appetite

Treatment Approach

Symptomatic Management

1. Pain and Fever Control

   • Acetaminophen or ibuprofen for fever and pain relief
   • Avoid aspirin in children due to risk of Reye syndrome

2. Oral Lesion Management

   • Cold foods (popsicles, ice cream) to soothe oral discomfort
   • Soft, non-acidic foods that don't require much chewing
   • Avoid spicy, salty, acidic foods and beverages that may irritate mouth sores
   • Oral rinses with warm salt water may provide relief

3. Hydration

   • Ensure adequate fluid intake to prevent dehydration
   • Small, frequent sips of water or electrolyte solutions
   • Consider using straws to bypass painful oral lesions

4. Skin Lesion Care

   • Keep skin lesions clean and dry
   • Gentle cleansing with mild soap and water
   • Topical moisturizers may help with discomfort

Special Considerations

• Severe Cases: Most cases are mild, but severe cases (particularly those caused by Enterovirus A71) may require hospitalization for monitoring and supportive care 2

• Neurological Complications: In rare cases where neurological complications develop (such as meningoencephalitis or brainstem encephalitis), intravenous immunoglobulin and glucocorticoid therapies may be considered 3

Warning Signs Requiring Medical Attention

Patients and caregivers should seek immediate medical attention if the following occur:

• Persistent high fever
• Neurological symptoms (headache, stiff neck, irritability, altered consciousness)
• Signs of dehydration (decreased urine output, dry mouth, lethargy)
• Difficulty breathing
• Rapid heart rate

Prevention Measures

• Isolation of affected individuals to prevent cross-infection
• Frequent handwashing with soap and water
• Disinfection of contaminated surfaces and toys
• Avoiding close contact (kissing, hugging) with infected individuals
• Proper disposal of tissues and diapers

Prognosis

The prognosis for HFMD is excellent in most cases, with complete recovery within 7-10 days without sequelae. Nail changes (dystrophy or shedding) may occur weeks after the initial infection but typically resolve without intervention 4.

Key Points for Clinicians

• HFMD is primarily caused by enteroviruses, with coxsackievirus A16 and enterovirus A71 being the most common pathogens
• EV-A71 infections tend to be more severe and have higher rates of complications than other viral causes 1
• No specific antiviral therapy is currently approved for HFMD
• Early recognition of severe cases is crucial to prevent progression to critical disease 2
• Treatment is focused on symptom management and prevention of complications

Remember that while HFMD is typically a benign, self-limited condition, close monitoring for complications is essential, particularly in children under 3 years of age with EV-A71 infection 2.