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

Treatment for Hand, Foot, and Mouth Disease

The treatment for hand, foot, and mouth disease is primarily supportive care focused on hydration and pain relief with acetaminophen or ibuprofen, as the condition is self-limiting and typically resolves within 7-10 days without specific antiviral therapy. 1

Disease Overview

Hand, foot, and mouth disease (HFMD) is a common viral illness primarily affecting children under 5 years of age, though it can occasionally affect adults. It is caused by human enteroviruses, most commonly:

• Coxsackievirus A16 (CVA16)
• Enterovirus A71 (EV-A71)
• Coxsackievirus A6 (CVA6)

The disease is highly contagious and transmitted through:

• Fecal-oral contact
• Oral-oral contact
• Respiratory droplets
• Contact with contaminated surfaces and fomites

Clinical Presentation

Typical symptoms include:

• Low-grade fever
• Malaise and myalgia
• Painful oral ulcerations/enanthem
• Maculopapular or papulovesicular rash on hands and feet
• Lesions may also appear on buttocks and genitalia

Treatment Approach

1. Supportive Care

• Hydration: Encourage adequate fluid intake despite painful oral lesions 1
• Pain management:
  • Acetaminophen or ibuprofen as needed for pain and fever 1, 2
  • Avoid oral lidocaine (not recommended) 1

2. Symptom Management

• For oral lesions:
  • Cold liquids, ice pops, or ice chips to soothe mouth pain
  • Soft, non-acidic foods
  • Avoid spicy, salty, or acidic foods and beverages that may irritate mouth sores

3. Important Treatment Considerations

• No specific antiviral treatment is currently available for HFMD 1, 2
• Oral lidocaine is not recommended due to risk of numbing the gag reflex 1
• Intravenous immunoglobulin may be considered only for severe/complicated cases (rare in North America) 2

Prevention of Spread

• Handwashing: Thorough handwashing is the most effective preventive measure 1
• Surface disinfection: Clean potentially contaminated surfaces and fomites 1
• Isolation: Children should stay home from school or daycare until fever resolves and mouth sores heal
• Avoid close contact: Minimize kissing, hugging, and sharing utensils or cups during active infection

When to Seek Medical Attention

Patients should seek immediate medical care if they develop:

• Signs of dehydration
• Persistent high fever
• Neurological symptoms (headache, stiff neck, seizures)
• Respiratory distress
• Unusual lethargy or irritability

Prognosis

• Most cases resolve completely within 7-10 days without complications 1, 2
• Nail changes (shedding) may occur weeks after the infection 3
• Severe complications are rare but can include meningitis, encephalitis, and cardiopulmonary issues, particularly with EV-A71 infections 2, 4

Key Points for Clinicians

• HFMD is typically self-limiting with complete recovery within 7-10 days
• Treatment focuses on symptom management rather than antiviral therapy
• Handwashing and disinfection are crucial for preventing spread
• Recognize atypical presentations, especially in patients with atopic dermatitis ("eczema coxsackium") 3
• Be aware of potential for adult infection through household transmission 5

Remember that while HFMD is usually mild, early recognition of severe cases is important to monitor for rare but serious complications.