What is the recommended treatment for Hand, Foot, and Mouth Disease (HFMD) virus?

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

The recommended treatment for Hand, Foot, and Mouth Disease is primarily supportive care, as HFMD is a self-limiting viral illness that typically resolves within 7-10 days without specific antiviral therapy. 1, 2

Disease Overview

HFMD is a highly contagious viral illness primarily affecting children under 5 years of age, though it can occur in adults. It is caused by several enteroviruses, most commonly:

• Coxsackievirus A16
• Enterovirus 71 (associated with more severe cases)
• Coxsackievirus A6 and A10 (emerging causes)

The disease is characterized by:

• Fever
• Painful oral lesions/ulcers
• Vesicular rashes on hands, feet, and sometimes buttocks

Treatment Approach

Supportive Care (First-line)

1. Fever management:

   • Acetaminophen or ibuprofen for fever and pain relief
   • Avoid aspirin in children due to risk of Reye syndrome

2. Oral pain management:

   • Topical oral anesthetics (e.g., viscous lidocaine) for mouth sores
   • Cold foods like popsicles, ice cream, or cold beverages
   • Soft, non-acidic foods to avoid irritating mouth sores

3. Hydration:

   • Ensure adequate fluid intake to prevent dehydration
   • Cold milk, water, or oral rehydration solutions
   • IV fluids may be necessary in severe cases with inability to maintain oral hydration

4. Skin care:

   • Keep lesions clean and dry
   • Calamine lotion may provide relief for itchy lesions

Monitoring for Complications

Monitor for rare but serious complications, particularly with EV-A71 infection 1, 3:

• Neurological complications (encephalitis, meningitis, acute flaccid paralysis)
• Cardiopulmonary complications
• Dehydration due to painful oral lesions limiting intake

Special Considerations

For severe cases (uncommon but more frequent with EV-A71):

• Intravenous immunoglobulin has been recommended by several guideline committees for severe/complicated HFMD 2
• Hospital admission for supportive care and monitoring if:
  • Persistent high fever
  • Neurological symptoms
  • Respiratory distress
  • Inability to maintain hydration

Prevention Measures

1. Hand hygiene:

   • Thorough handwashing with soap and water for at least 15 seconds
   • Alcohol-based hand sanitizers when soap and water aren't available 1

2. Environmental cleaning:

   • Disinfect frequently touched surfaces and shared toys
   • Wash soiled clothing, bedding, and towels in hot water with detergent 1

3. Isolation precautions:

   • Avoid close contact with infected individuals
   • Children should stay home from school/daycare until fever-free for 24 hours and most lesions have dried 1

Return to Normal Activities

Children may return to daycare or school when 1:

• Fever-free for 24 hours without medication
• Feel well enough to participate in activities
• Most lesions have dried

Research Developments

While there is currently no approved specific antiviral therapy for HFMD in the United States, research is ongoing:

• A formalin-inactivated EV-A71 vaccine has been approved in China 3
• Potential antiviral agents under investigation include ribavirin, suramin, aminothiazole analogs, and sertraline 2

Common Pitfalls to Avoid

1. Misdiagnosis: HFMD can be confused with other vesicular rashes, particularly in atypical presentations. In children with atopic dermatitis, "eczema coxsackium" can mimic herpetic superinfection 4.

2. Underestimating severity: While most cases are mild, be vigilant for signs of severe disease, particularly with EV-A71 infection.

3. Unnecessary antibiotics: HFMD is viral; antibiotics are not indicated unless there is evidence of secondary bacterial infection.

4. Inadequate hydration monitoring: Painful oral lesions may significantly limit fluid intake, leading to dehydration.