Treatment of Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease (HFMD) is primarily managed with supportive care, as it is typically a self-limiting viral illness that resolves within 7-10 days without specific antiviral treatment.
Diagnosis
- HFMD is characterized by low-grade fever, painful oral ulcerations, and a maculopapular or papulovesicular rash on the hands and soles of the feet 1
- Vesicle fluid samples have high viral loads and are ideal for testing, with RT-PCR being the preferred diagnostic method 2
- Respiratory samples and stool specimens can also be used for diagnosis 2
Treatment Approach
Supportive Care
- Oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 2, 1
- Ensure adequate hydration, especially when oral lesions make eating and drinking painful 1
- Avoid spicy, salty, or acidic foods that may irritate oral lesions 2
Management of Oral Lesions
- Mild toothpaste and gentle oral hygiene for oral lesions 2
- Cold foods like popsicles or ice cream may provide temporary relief for oral discomfort 1
- Oral lidocaine is not recommended for pain management 1
Management of Skin Manifestations
- Intensive skin care with moisturizing creams (e.g., urea cream/ointment) 2
- Avoid friction and heat exposure to affected areas 2
- Treat any secondary bacterial infections that may develop 2
Special Considerations
- Immunocompromised patients may experience more severe disease and should be monitored closely 2
- Severe cases with neurologic or cardiopulmonary complications are rare but require immediate medical attention 1, 3
- Intravenous immunoglobulin should be considered for severe/complicated HFMD cases 3
Prevention and Control
- Thorough handwashing with soap and water is the most important preventive measure 2
- Environmental cleaning, particularly of toys and objects that may be placed in children's mouths 2
- Children with HFMD should avoid close contact with others until fever resolves and mouth sores heal 2, 4
Course and Prognosis
- Most cases resolve within 7-10 days without sequelae 1, 3
- Nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptoms 5
- Severe complications such as meningitis, encephalitis, or myocardial impairment are rare but possible, particularly with Enterovirus A71 infections 3