Treatment of Hand, Foot, and Mouth Disease (HFMD)
The recommended treatment for Hand, Foot, and Mouth Disease is primarily supportive care, as it is typically a self-limiting viral illness that resolves within 7-10 days without specific antiviral therapy. 1, 2
Supportive Care Measures
Pain and Fever Management
- Use acetaminophen or ibuprofen for fever and pain relief
- Avoid aspirin in children due to risk of Reye syndrome
- For oral lesions:
- Cold liquids, ice chips, or popsicles to soothe pain
- Soft, non-acidic foods that don't require much chewing
- Oral rinses with warm salt water for older children
Hydration
- Maintain adequate fluid intake to prevent dehydration
- Small, frequent sips of fluids if painful oral lesions make drinking difficult
- Monitor for signs of dehydration (decreased urination, dry mouth, lethargy)
Skin Care
- Keep lesions clean and dry
- For itchy lesions, consider calamine lotion
- For painful lesions on hands and feet, topical lidocaine may provide relief 1
Special Considerations
Atypical Presentations
- "Eczema coxsackium" can occur in children with atopic dermatitis, resembling herpetic superinfection 3
- Nail changes, including shedding, may follow HFMD after a latency period 3
Severe Cases
- Intravenous immunoglobulin should be considered for severe/complicated HFMD 2
- Monitor for neurological complications, particularly with Enterovirus 71 infections 4, 5
- Signs requiring immediate medical attention:
- Persistent high fever
- Severe headache or stiff neck
- Unusual sleepiness or lethargy
- Difficulty breathing 1
Prevention of Transmission
Personal Hygiene
- Thorough handwashing with soap and water for at least 15 seconds, especially after diaper changes 1
- Use alcohol-based hand sanitizers when soap and water aren't available 1
- Avoid close contact with infected individuals 1
Environmental Measures
- Disinfect frequently touched surfaces and shared toys 1
- Wash soiled clothing, bedding, and towels in hot water with detergent 1
- Avoid sharing personal items like utensils and towels 1
Return to School/Daycare
- Children may return when:
- Fever-free for 24 hours without medication
- Feel well enough to participate in activities
- Most lesions have dried 1
Future Directions
While no specific antiviral therapy is currently approved for HFMD, research is ongoing. Vaccines against Enterovirus 71 have been developed in some Asian countries, but these do not protect against other causative agents like Coxsackievirus A16, A6, and A10 5, 6. A multivalent vaccine approach may be the best strategy for future prevention 5.