What is the management for hand, foot, and mouth disease?

Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is primarily managed with supportive care as it is typically a self-limiting viral illness that resolves within 7-10 days without specific treatment.

Clinical Features and Diagnosis

• HFMD is a common viral illness primarily affecting children under 5 years of age
• Characterized by:
  • Low-grade fever
  • Painful oral ulcerations/enanthem
  • Maculopapular or papulovesicular rash on hands and feet
  • Possible vesicular lesions on buttocks and genitalia
• Causative agents: Human enteroviruses, most commonly coxsackievirus A16 and enterovirus A71 (EV-A71)
• Transmission: Fecal-oral, oral-oral, and respiratory droplet contact 1, 2

Management Approach

Supportive Care (First-line)

1. Hydration

   • Ensure adequate fluid intake
   • Consider cold fluids, popsicles, or ice cream to soothe oral pain and maintain hydration
   • Avoid acidic, spicy, or hot foods/beverages that may exacerbate oral pain

2. Pain Management

   • Acetaminophen or ibuprofen for pain relief and fever control
   • Dose appropriately based on patient's age and weight
   • Note: Oral lidocaine is NOT recommended 2

3. Oral Care

   • Gentle mouth rinses with warm salt water
   • Soft diet to minimize discomfort while eating

Prevention of Spread

• Handwashing is the most effective preventive measure
• Disinfection of potentially contaminated surfaces and fomites
• Isolation from school/daycare until fever resolves and lesions begin to heal
• Avoid close contact with infected individuals 2

Special Considerations

When to Seek Medical Attention

• Signs of dehydration (dry mouth, decreased urination, lethargy)
• Persistent high fever (>101°F or 38.3°C) for more than 3 days
• Severe headache, neck stiffness, or altered mental status
• Difficulty breathing or rapid breathing
• Persistent vomiting

Monitoring for Complications

• Neurological complications (rare but serious):
  • Meningoencephalitis
  • Brainstem encephalitis
  • Myoclonic jerks or seizures
  • Altered consciousness
• Cardiopulmonary complications (very rare):
  • Myocardial impairment
  • Neurogenic pulmonary edema 3, 4

High-Risk Patients

• Children infected with EV-A71 have higher risk of severe complications compared to other causative viruses
• Children under 5 years of age, particularly infants, are at higher risk for complications
• Immunocompromised patients may experience prolonged or more severe illness 1, 3

Treatment for Severe Cases

• Hospitalization for monitoring and supportive care
• Intravenous fluids for dehydration
• Intravenous immunoglobulin (IVIG) should be considered for severe/complicated HFMD 3
• Currently, no specific antiviral agents are approved for HFMD treatment 1, 2, 3

Follow-up

• Most cases resolve completely within 7-10 days without sequelae
• Nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptoms
• Neurological sequelae may require long-term follow-up in severe cases 5, 4

Prevention

• Good personal hygiene, especially handwashing
• Avoiding close contact with infected individuals
• Proper disinfection of contaminated surfaces
• In high-risk areas, EV-A71 vaccination may provide protection against EV-A71-related HFMD, though it does not protect against other causative viruses 1