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

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

Hand, foot, and mouth disease (HFMD) is primarily managed with supportive care as it typically resolves spontaneously within a few days without complications in most cases. 1

Clinical Presentation and Etiology

• HFMD is a common viral illness primarily affecting children under 5 years of age, characterized by oral sores and rashes on the palms of hands and soles of feet 1, 2
• The disease is caused by various enteroviruses, with enterovirus A71 (EV-A71) and coxsackievirus A16 traditionally being the most common causative agents 3
• Recent epidemiological shifts show increasing prevalence of coxsackievirus A6 and coxsackievirus A10 as causative agents 3

Supportive Treatment Approach

• HFMD is typically self-limiting with symptoms resolving within 7-10 days without specific treatment 1
• The primary treatment focuses on symptom management and supportive care:
  • Adequate fluid intake to prevent dehydration, especially when oral sores make drinking painful 4
  • Acetaminophen or ibuprofen for fever and pain management 4
  • Cold foods like popsicles or ice cream to soothe mouth sores 4
  • Avoidance of spicy, salty, or acidic foods that may irritate mouth sores 4

Management of Complications

• While most cases are mild, clinicians should monitor for potential neurological complications such as brain stem encephalitis, meningoencephalitis, and acute flaccid paralysis 1, 3
• Severe cases may require hospitalization for:
  • Intravenous fluid administration for dehydration 4
  • Monitoring and management of neurological complications 3
  • Respiratory support in rare cases of pulmonary edema 3

Infection Control Measures

• HFMD is highly contagious, requiring appropriate infection control measures 5:
  • Frequent handwashing with soap and water, especially after diaper changes and before eating 4
  • Disinfection of contaminated surfaces and toys 4
  • Avoiding close contact (kissing, hugging, sharing utensils) with infected individuals 4
  • Temporary exclusion from school or childcare facilities until fever subsides and mouth sores heal 4

Prevention

• Currently, there is no specific pharmaceutical intervention universally available for HFMD 1
• An inactivated EV-A71 vaccine has been approved in China and shows high protection against EV-A71-related HFMD 1
• However, the vaccine's effectiveness is limited by the simultaneous circulation of multiple pathogens 1, 4
• Research on multivalent vaccines is ongoing but faces challenges due to the evolving molecular epidemiology of causative agents 4

Follow-up Considerations

• Nail dystrophies (such as Beau's lines or nail shedding) may occur weeks after initial symptom onset 2
• Long-term follow-up may be necessary for patients who experienced severe neurological complications 1, 3

Emerging Research

• Drug repositioning studies are exploring potential antiviral treatments for HFMD using existing approved or investigational drugs 5
• Various types of drugs including antibacterial, cardiovascular, and anticancer agents are being studied for their therapeutic potential against HFMD 5
• However, no specific antiviral therapy is currently recommended for routine clinical practice 1, 5