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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limiting viral illness that requires supportive care focused on hydration and pain relief with acetaminophen or ibuprofen as the mainstay of treatment. 1

Disease Overview

Hand, foot, and mouth disease is a common viral infection caused primarily by enteroviruses, particularly coxsackieviruses. It predominantly affects children under 10 years of age but can also affect adults. The disease is characterized by:

• Low-grade fever
• Painful oral ulcerations/sores
• Maculopapular or papulovesicular rash on hands and feet
• Possible vesicular lesions on buttocks

The disease is highly contagious and transmitted through:

• Fecal-oral contact
• Oral-oral contact
• Respiratory droplets

Diagnosis

Diagnosis is primarily clinical, based on the characteristic presentation:

• Fever
• Painful oral ulcerations (often the first clinical sign) 2
• Rash on palms of hands and soles of feet
• Lesions may also appear on buttocks or trunk (especially with Coxsackievirus A6) 3

Treatment Approach

Non-pharmacological Management

1. Hydration

   • Encourage fluid intake
   • Cold liquids, popsicles, or ice cream may soothe oral pain
   • Avoid acidic, spicy, or salty foods that may irritate mouth sores

2. Rest

   • Adequate rest until fever resolves and symptoms improve

3. Hygiene measures to prevent spread

   • Frequent handwashing
   • Disinfection of potentially contaminated surfaces and fomites 1
   • Avoiding close contact with infected individuals

Pharmacological Management

1. Pain and fever management

   • Acetaminophen or ibuprofen as needed for pain relief and fever reduction 1
   • Dosing based on age and weight

2. Oral care

   • Oral lidocaine is NOT recommended 1
   • Saltwater rinses may provide some relief for older children and adults

3. Topical treatments

   • No specific topical treatments have been proven effective
   • Calamine lotion may provide some symptomatic relief for skin lesions

Special Considerations

1. When to seek medical attention

   • Persistent high fever
   • Signs of dehydration (dry mouth, decreased urination)
   • Neurological symptoms (headache, stiff neck, irritability)
   • Symptoms not improving after 7-10 days

2. Complications

   • Rare but can include neurologic complications (encephalitis, meningitis)
   • Cardiopulmonary complications in severe cases 1
   • Nail dystrophies (e.g., Beau's lines, nail shedding) may occur weeks after initial infection 4

Prevention

1. Handwashing

   • Thorough handwashing with soap and water, especially after diaper changes and before handling food

2. Environmental cleaning

   • Disinfection of surfaces and toys
   • Proper disposal of tissues and diapers

3. Isolation

   • Children should stay home from school or daycare until fever is gone and mouth sores have healed
   • Adults should avoid work while symptomatic

Prognosis

HFMD is typically self-limiting with complete resolution of symptoms within 7-10 days 1. Most patients recover fully without specific antiviral treatment. Recurrence is possible as different enterovirus strains can cause subsequent infections.