Treatment of Hand, Foot, and Mouth Disease
The treatment of Hand, Foot, and Mouth Disease (HFMD) is primarily symptomatic and supportive, as there are no specific antiviral agents approved for this condition. 1, 2
Clinical Assessment
When evaluating a patient with suspected HFMD, focus on:
- Age (children under 5 years are most commonly affected)
- Presence of typical manifestations:
- Oral enanthem (painful lesions in the mouth)
- Maculopapular or vesicular eruptions on palms and soles
- Signs of potential complications:
- Persistent high fever
- Neurological symptoms (headache, myoclonic jerks, seizures)
- Abnormal respiratory rate or rhythm
- Circulatory dysfunction
Treatment Approach
1. Symptomatic Management
Pain control:
- Acetaminophen or ibuprofen for pain and fever 1
- Avoid aspirin in children due to risk of Reye syndrome
Oral lesion management:
- Cold, bland, non-acidic foods and beverages
- Avoid spicy, salty, or acidic foods that may irritate oral lesions
Skin care:
- Intensive skin care with urea cream (10%) on hands and feet 1
- Avoid friction and heat in affected areas
2. Hydration
- Ensure adequate fluid intake to prevent dehydration, especially important as oral lesions may make drinking painful 1
- Consider hospital admission for IV fluids if unable to maintain oral hydration
3. Monitoring for Complications
Monitor for warning signs that may indicate severe disease, particularly in:
- Children under 3 years of age
- Patients with disease duration less than 3 days
- Cases caused by enterovirus A71 (EV-A71) 3
Warning signs include:
- Persistent hyperthermia
- Neurological involvement
- Worsening respiratory pattern
- Circulatory dysfunction
- Elevated WBC count
- Elevated blood glucose
- Elevated blood lactic acid 3
4. Management of Severe Cases
For severe HFMD with neurological complications:
- Hospital admission for close monitoring
- Intravenous immunoglobulin should be considered 2, 4
- Glucocorticoid therapy may be beneficial in severe cases 4
Prevention Measures
- Isolation: Isolate affected individuals to prevent cross-infection 3
- Hygiene: Emphasize good hand hygiene and avoid close contact with infected individuals
- Vaccination: In regions where available, EV-A71 vaccine provides protection against EV-A71-related HFMD 5
Prognosis
Most cases of HFMD are benign and self-limiting, resolving within 7-10 days without sequelae 2. However, severe cases, particularly those caused by EV-A71, can lead to serious neurological complications and, rarely, death due to circulatory failure or neurogenic pulmonary edema 2, 5.
Common Pitfalls to Avoid
Failure to recognize severe disease: Early recognition of stages 2 and 3 of HFMD is crucial to prevent progression to critical stage 4 3
Inadequate hydration: Painful oral lesions may lead to decreased fluid intake and dehydration
Inappropriate antibiotic use: HFMD is viral in nature, and antibiotics are not indicated unless there is evidence of secondary bacterial infection
Missing atypical presentations: Some cases may present with atypical manifestations, particularly those caused by coxsackievirus A6, which can affect adults and cause more severe symptoms 6
Overlooking potential complications: Be vigilant for neurological complications, especially in young children with EV-A71 infection 4