What is the recommended management for hand foot mouth disease?

Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness that typically resolves within 7-10 days without specific antiviral treatment; management should focus on supportive care including adequate hydration and pain control with acetaminophen or ibuprofen as needed.

Clinical Presentation and Etiology

• HFMD is a common viral illness caused by human enteroviruses and coxsackieviruses, predominantly affecting children under 5 years of age 1, 2
• The disease is characterized by low-grade fever, painful oral ulcerations, and a maculopapular or papulovesicular rash typically on the hands, feet (particularly the palms and soles), and sometimes buttocks 1, 3
• HFMD is highly contagious and transmitted through fecal-oral, oral-oral, and respiratory droplet contact 1
• Outbreaks commonly occur during spring to fall seasons in North America 1

Diagnosis

• Diagnosis is primarily clinical, based on the characteristic presentation of fever, oral ulcerations, and rash on hands and feet 1, 4
• The differential diagnosis includes erythema multiforme, herpes, measles, and varicella 1
• Most cases are caused by coxsackievirus A16 in the United States, though coxsackievirus A6 has been associated with more severe presentations 2, 4
• Enterovirus A71 (EV-A71) is associated with more severe disease and higher complication rates 4, 5

Treatment Approach

• Treatment is primarily supportive as HFMD is typically self-limited 1, 4
• Key management strategies include:
  • Ensuring adequate hydration, which may be challenging due to painful oral ulcers 1, 4
  • Pain management with acetaminophen or ibuprofen as needed 1
  • Topical oral anesthetics containing lidocaine are not recommended 1
  • Currently, no specific antiviral treatments are approved for HFMD 1, 4

Complications and Special Considerations

• While most cases resolve without sequelae in 7-10 days, rare but serious complications can occur 1, 4
• Potential complications include:
  • Neurological complications (particularly with EV-A71 infections) 4, 5
  • Cardiopulmonary complications in severe cases 5
  • Nail dystrophies (e.g., Beau's lines or nail shedding) that may appear weeks after initial symptoms 2
• Intravenous immunoglobulin should be considered for severe/complicated HFMD cases as recommended by several guideline committees 4
• Patients with severe symptoms including signs of neurological involvement require close monitoring and may need hospitalization 4, 5

Prevention

• The most effective prevention methods include:
  • Proper handwashing, especially after diaper changes and before handling food 1
  • Disinfection of potentially contaminated surfaces and fomites 1
  • Avoiding close contact with infected individuals 4
  • In high-risk areas, vaccination against EV-A71 may be considered, though it only protects against one causative agent 5
• Children should be kept home from school or daycare during the acute illness phase to prevent transmission 1, 4

Follow-up

• Most patients with uncomplicated HFMD do not require specific follow-up as the disease is self-limited 1, 4
• Parents and caregivers should be educated about potential warning signs that would warrant medical attention, such as persistent high fever, severe headache, stiff neck, or persistent vomiting 4, 5