Treatment for 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 is primarily supportive and focused on symptom relief, hydration, and pain control with acetaminophen or ibuprofen as needed. 1, 2
Disease Overview
- HFMD is caused by human enteroviruses, most commonly coxsackievirus A16, though enterovirus A71, coxsackievirus A6, and coxsackievirus A10 are increasingly identified as causative agents 1, 3
- The disease primarily affects children under 5 years of age but can occur in older children and adults 1
- Transmission occurs through fecal-oral, oral-oral, and respiratory droplet contact 1
- Outbreaks typically occur during spring to fall months in North America 1
Clinical Presentation
- Low-grade fever is often the initial symptom 1
- Painful oral ulcerations (enanthem) develop, making eating and drinking difficult 1, 2
- Maculopapular or papulovesicular rash appears on the hands, feet (particularly palms and soles), and sometimes buttocks 1, 4
- Lesions typically resolve in 7-10 days without scarring 1
- Nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptoms 5
Treatment Approach
Supportive Care
- Ensure adequate hydration, which may be challenging due to painful oral lesions 1, 2
- Offer cold, soft foods and liquids that don't require much chewing 2
- Avoid acidic, salty, or spicy foods that may irritate oral lesions 2
Pain Management
- Acetaminophen or ibuprofen can be used for pain relief and fever reduction 1
- Topical oral anesthetics may provide temporary relief, but oral lidocaine is not recommended due to risk of numbing the gag reflex 1
- Cold liquids, ice chips, or popsicles may help soothe oral discomfort 2
When to Seek Medical Attention
- Most cases resolve without complications, but rare neurologic or cardiopulmonary complications can occur 1, 3
- Seek medical attention if:
Special Considerations
- HFMD caused by enterovirus A71 tends to be more severe and has higher rates of complications than other viral causes 2, 3
- In severe cases (rare in the US but more common in some Asian countries), intravenous immunoglobulin may be considered 2
- Currently, no specific antiviral agents are approved for HFMD treatment 2
Prevention
- Handwashing is the most effective preventive measure, especially after diaper changes and before handling food 1
- Disinfect frequently touched surfaces and items (toys, doorknobs, etc.) 1
- Avoid close contact with infected individuals 2
- Children should stay home from school or daycare until fever resolves and mouth sores heal 2
- Vaccines against enterovirus A71 are available in China but not in the United States 3