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

Treatment of Hand, Foot, and Mouth Disease

The treatment of hand, foot, and mouth disease (HFMD) is primarily supportive and symptomatic, as it is typically a self-limiting viral illness that resolves within 7-10 days without specific antiviral therapy.

Diagnosis

• HFMD is characterized by fever, painful oral ulcers, and vesicular rashes on the hands, feet, and buttocks 1, 2
• Vesicle fluid samples have the highest viral loads and are ideal for diagnostic testing using reverse transcriptase PCR (RT-PCR) 3
• Respiratory samples and stool specimens can also be used for diagnosis 3

Supportive Care Measures

• Pain management: Use oral analgesics such as acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 4
• Oral hydration: Encourage adequate fluid intake to prevent dehydration, especially when oral ulcers make eating and drinking painful 5
• Soft diet: Recommend cold, soft foods that are easy to swallow and avoid spicy, salty, or acidic foods that may irritate mouth sores 5
• Oral hygiene: Mild toothpaste and gentle oral hygiene are recommended to manage oral lesions 4

Management of Specific Symptoms

For Oral Lesions/Stomatitis

• Early intervention is recommended for oral lesions 4
• For severe oral ulcers (>grade 2), consider delaying normal activities until symptoms resolve 4
• Consider using topical oral anesthetics to relieve pain from mouth sores 5

For Skin Manifestations (Hand and Foot Lesions)

• Intensive skin care of hands and feet with moisturizing creams (such as urea cream/ointment) is recommended 4
• Treatment of any secondary bacterial infections if they develop 4
• Avoid friction and heat exposure to affected areas 4

Prevention and Control Measures

• Hand hygiene is the most important preventive measure, with thorough handwashing with soap and water being more effective than alcohol-based sanitizers 3
• Environmental cleaning, particularly of toys and objects that may be placed in children's mouths 3
• Children with HFMD should avoid close contact with others until fever resolves and mouth sores heal 3, 6
• Standard precautions should be followed in healthcare settings 3

Special Considerations

• Immunocompromised patients may experience more severe disease and should be monitored closely 3
• For severe cases with neurological complications (rare but more common with enterovirus A71), intravenous immunoglobulin may be considered 5
• Most infections are asymptomatic; symptomatic cases typically present with mild febrile illness 6
• HFMD can be associated with nail dystrophies (e.g., Beau's lines or nail shedding) weeks after initial symptom onset 6

When to Seek Medical Attention

• Persistent high fever beyond 3 days 5
• Signs of dehydration due to difficulty swallowing 5
• Development of neurological symptoms such as persistent headache, neck stiffness, or altered mental status 2, 5

Prognosis

• The disease is usually benign and resolves in 7-10 days without sequelae 5
• Complications are rare but can include meningitis, encephalitis, and acute flaccid paralysis in a small proportion of children 2

Common Pitfalls to Avoid

• Overuse of antibiotics, which are ineffective against viral infections 5
• Delaying supportive care, which can lead to dehydration, especially in young children 5
• Failing to implement proper isolation measures, which can lead to outbreaks in childcare settings 3, 6