Management of Hand, Foot, and Mouth Disease
Treatment for hand, foot, and mouth disease is primarily supportive and focused on symptom relief, as the condition is typically self-limiting and resolves within 7-10 days without specific antiviral therapy.
Disease Overview
Hand, foot, and mouth disease (HFMD) is a common viral illness caused by enteroviruses, most commonly coxsackievirus A16 and enterovirus A71. It primarily affects children under 5 years of age, though adults can also be affected. The disease is characterized by:
- Low-grade fever
- Painful oral ulcerations/enanthem
- Maculopapular or papulovesicular rash on hands and soles of feet
- Typically resolves in 7-10 days without complications
Supportive Treatment Recommendations
Pain and Fever Management
- Acetaminophen or ibuprofen as needed for pain relief and fever control 1
- Oral lidocaine is NOT recommended 1
Hydration
- Ensure adequate fluid intake
- Cold fluids, popsicles, or ice cream may help soothe oral pain and maintain hydration
- Avoid acidic, salty, or spicy foods that may irritate oral lesions
Oral Care
- Gentle rinsing with warm salt water for older children
- Regular oral hygiene with soft toothbrush
Skin Care
- For skin lesions, keep areas clean and dry
- Intensive skin care with urea cream/ointment may be beneficial for hand lesions based on evidence from hand-foot syndrome management 2
Special Considerations
Severe Cases
- Most cases are mild and self-limiting
- In rare cases, enterovirus A71 can cause severe complications including neurologic or cardiopulmonary issues 3, 4
- Hospitalization may be required for:
- Inability to maintain hydration
- Neurological complications
- Cardiopulmonary complications
Atypical Presentations
- Children with atopic dermatitis may develop "eczema coxsackium," which can resemble herpetic infection 5
- Nail changes (dystrophy or shedding) may occur weeks after initial infection 6
Prevention Strategies
Hygiene Measures
- Handwashing is the most effective prevention method 1
- Disinfection of potentially contaminated surfaces and fomites
- Avoid close contact with infected individuals
Additional Prevention Measures
- Avoid sharing utensils or personal items
- Proper disposal of tissues and diapers
- Keep children home from school/daycare until fever subsides and mouth sores heal
Follow-up
- Routine follow-up is not necessary for uncomplicated cases
- Parents should seek medical attention if:
- Symptoms worsen or persist beyond 10 days
- Signs of dehydration develop
- Neurological symptoms appear (headache, irritability, lethargy)
Common Pitfalls to Avoid
- Using oral lidocaine (not recommended)
- Prescribing antibiotics (ineffective against viral infections)
- Failing to emphasize adequate hydration
- Missing atypical presentations in children with atopic dermatitis
Remember that while HFMD is typically a benign, self-limiting condition, proper supportive care is essential to maintain comfort and prevent complications related to dehydration or secondary infection.