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

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

The treatment for hand, foot, and mouth disease is primarily symptomatic and supportive, as the condition is typically self-limiting and resolves within 7-10 days without specific antiviral therapy.

Disease Overview

Hand, foot, and mouth disease is a highly contagious viral illness that predominantly affects children under 5 years of age. It is caused by several enteroviruses, most commonly:

• Coxsackievirus A16
• Enterovirus A71 (associated with more severe cases)
• Coxsackievirus A6 and A10 (emerging causes in recent years)

The disease is characterized by:

• Fever
• Sore throat
• Painful oral ulcers/enanthem
• Maculopapular or vesicular rash on hands, feet, and sometimes buttocks

Treatment Approach

Symptomatic Management

1. Pain and fever control:

   • Acetaminophen (paracetamol) for pain relief and fever reduction
   • Topical oral pain relievers for mouth sores
   • Avoid aspirin in children due to risk of Reye's syndrome

2. Hydration management:

   • Encourage fluid intake to prevent dehydration
   • Offer cold, soft foods (ice cream, yogurt, smoothies) that are easier to swallow
   • Avoid acidic, salty, or spicy foods that may irritate mouth sores

3. Oral hygiene:

   • Gentle mouth rinses with warm salt water
   • Soft toothbrushes to minimize discomfort

Specific Considerations for Skin Lesions

For hand and foot lesions, the European Society for Medical Oncology recommends 1:

• Early intervention for developing lesions
• Intensive skin care of hands and feet (urea cream/ointment)
• Comfortable shoes and avoidance of friction and heat
• Treatment of any hyperkeratosis/fungal infections

When to Consider Additional Interventions

Most cases of HFMD are mild and self-limiting, but monitoring for complications is essential, particularly with EV-A71 infections, which can lead to:

• Neurological complications (encephalitis, meningitis, acute flaccid paralysis)
• Cardiopulmonary complications
• Severe respiratory symptoms including pulmonary edema

For severe cases with complications, consider:

• Hospitalization for supportive care
• Intravenous fluids if unable to maintain oral hydration
• Intravenous immunoglobulin for severe/complicated cases 2

Prevention Strategies

• Good hand hygiene
• Avoiding close contact with infected individuals
• Disinfection of contaminated surfaces
• Isolation of infected children from school/daycare until fever subsides and lesions heal

Important Clinical Considerations

1. No specific antiviral therapy is currently approved for routine treatment of HFMD 2, 3

2. Emerging antiviral candidates under investigation include ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline, but none are currently recommended for routine use 2

3. Vaccine status: An inactivated EV-A71 vaccine has been approved in China but is not available globally. This vaccine only protects against EV-A71 and not other causative agents 3

4. Monitoring for complications: While most cases resolve without sequelae, clinicians should monitor for neurological complications, especially with EV-A71 infections

5. Atypical presentations: Recent outbreaks of coxsackievirus A6 have been associated with more severe symptoms and onychomadesis (nail shedding) occurring up to two months after initial symptoms 4

The prognosis for most HFMD cases is excellent, with complete recovery within 7-10 days. However, early recognition of severe cases is crucial for appropriate management and prevention of complications.