What is the recommended treatment for Hand, Foot, and Mouth (HFM) disease?

Treatment of Hand, Foot, and Mouth Disease (HFM)

Hand, foot, and mouth disease is a self-limiting viral illness that primarily requires supportive care focused on hydration and pain management with acetaminophen or ibuprofen, while avoiding oral lidocaine. 1

Clinical Presentation and Diagnosis

• Most commonly affects children under 5 years of age
• Caused by enteroviruses, particularly coxsackievirus A16 and enterovirus A71
• Characterized by:
  • Low-grade fever
  • Painful oral ulcerations/enanthem
  • Maculopapular or papulovesicular rash on hands and soles of feet
  • Lesions typically resolve in 7-10 days 1

Treatment Approach

First-Line Management (Mild Cases)

• Supportive care is the mainstay of treatment:
  • Ensure adequate hydration (cold fluids, popsicles)
  • Pain management with acetaminophen or ibuprofen as needed 1
  • Avoid oral lidocaine (not recommended) 1
  • No specific antiviral treatment is available 1, 2

Skin Care for Rash

• Keep affected skin areas clean and dry
• Apply urea cream (5-10%) for dry skin if needed 3
• Avoid irritants and mechanical stress on affected skin 4
• Use gentle pH-neutral cleansers with tepid water 3

Severe Cases

• Monitor for warning signs of severe disease:
  • Persistent high fever
  • Neurological involvement
  • Respiratory distress
  • Circulatory dysfunction 5
• Hospitalization may be required for:
  • Severe cases, particularly those caused by enterovirus A71
  • Children under 3 years with disease duration less than 3 days 5
  • Cases with neurological or cardiopulmonary complications 6

Special Considerations

• Intravenous immunoglobulin should be considered for severe/complicated HFM disease 2
• EV-A71 infections tend to be more severe and have higher rates of complications 2, 6

Prevention

• Handwashing is the most effective preventive measure 1
• Disinfect potentially contaminated surfaces and fomites 1
• Isolate affected individuals to prevent cross-infection 5
• In high-risk areas, vaccination against EV-A71 may be considered (where available) 6

Potential Complications

• Most cases resolve without sequelae
• Rare but serious complications include:
  • Neurologic complications (encephalitis, meningitis)
  • Cardiopulmonary complications
  • Nail dystrophies (often weeks after initial symptoms) 7

Follow-up

• Most patients recover completely within 7-10 days without specific treatment 2
• Monitor for rare complications, particularly in children infected with EV-A71
• No routine follow-up is necessary for uncomplicated cases

Common Pitfalls to Avoid

• Failing to recognize severe cases early, particularly those caused by EV-A71
• Using oral lidocaine for pain management (not recommended)
• Unnecessary antibiotic prescription (ineffective against viral infections)
• Inadequate hydration management (critical for recovery)
• Failing to implement proper isolation measures to prevent spread

Remember that while HFM is typically a benign, self-limiting condition, early recognition of severe cases is crucial to prevent progression to life-threatening complications, particularly in young children infected with EV-A71.