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

Treatment for Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is a self-limited viral illness that primarily requires symptomatic and supportive care, as there are no specific antiviral treatments approved for routine use.

Disease Overview

• HFMD is a common viral illness caused primarily by enteroviruses, most commonly coxsackievirus A16 and enterovirus A71 1, 2
• Primarily affects children under 5 years of age, but can occur in adults 3
• Characterized by fever, painful oral ulcers/enanthem, and skin rash (exanthem) on the palms, soles, and sometimes buttocks 2, 3
• Typically self-limited, resolving within 7-10 days without sequelae 2
• EV-A71 infections can be more severe with higher rates of complications 2

Management Approach

Symptomatic Relief for Oral Lesions

• Mild analgesics such as acetaminophen or ibuprofen for pain and fever control
• Oral rinses with cool water or ice chips to soothe oral lesions
• Soft, bland diet avoiding spicy, acidic, or hot foods that may irritate oral ulcers
• Adequate hydration is crucial, especially if oral pain limits intake

Skin Manifestations

• No specific treatment required for the rash
• Moisturizers may help with any associated dryness
• For pruritus (if present), topical moisturizers or mild corticosteroids may provide relief 4

Severe Cases

• Intravenous immunoglobulin should be considered for severe or complicated HFMD (particularly with neurological complications) 2
• Hospitalization may be necessary for:
  • Neurological complications
  • Dehydration due to poor oral intake
  • Circulatory failure or myocardial impairment (rare)
  • Neurogenic pulmonary edema (rare, but a potential cause of death) 2

Emerging Treatments

• Currently, no specific antiviral agents are approved for HFMD treatment
• Investigational agents include ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline 2

Prevention Measures

• Good hand hygiene practices
• Avoiding close contact with infected individuals
• Disinfection of contaminated surfaces and objects
• In high-risk areas, vaccination against EV-A71 may be available (approved in China) 5

Follow-up and Monitoring

• Most cases resolve without complications within 7-10 days 2
• Monitor for rare complications such as:
  • Neurological manifestations
  • Nail dystrophies (e.g., Beau's lines or nail shedding) which may appear weeks after initial symptoms 1
  • Cardiopulmonary complications (very rare) 5

Special Considerations

• Dental professionals should be aware of HFMD as oral lesions are often the first clinical signs 6
• Healthcare providers should report unusual clusters of cases to public health authorities
• HFMD outbreaks typically occur during summer and autumn months in the United States 1

The management of HFMD focuses primarily on symptom relief while the infection runs its course, with special attention to maintaining adequate hydration and monitoring for rare but serious complications.