What is the treatment for hand foot and mouth disease?

Treatment of Hand, Foot, and Mouth Disease

The treatment for hand, foot, and mouth disease is primarily supportive care focused on symptom management, including oral analgesics such as acetaminophen or NSAIDs for pain and fever relief, and ensuring adequate hydration. 1, 2

Clinical Features and Diagnosis

• Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness primarily caused by enteroviruses, including coxsackieviruses A6, A10, A16, and enterovirus 71 2, 3
• The disease typically presents with low-grade fever, painful oral ulcerations, and a maculopapular or papulovesicular rash on the hands and soles of the feet 2
• Diagnosis is primarily clinical, though laboratory confirmation can be achieved through RT-PCR testing of vesicle fluid samples, respiratory samples, or stool specimens 1
• Lesions usually resolve in 7-10 days without specific treatment 2

Treatment Approach

Supportive Care

• Acetaminophen or NSAIDs for pain relief and fever reduction 1, 2
• Adequate hydration is essential, especially when oral ulcers make drinking painful 1
• Avoid spicy, acidic, or hot foods and beverages that may irritate oral lesions 1

Management of Specific Symptoms

For Oral Lesions

• Mild toothpaste and gentle oral hygiene to manage oral ulcerations 1
• Cold liquids, ice chips, or popsicles may provide relief for oral discomfort 1
• Note: Oral lidocaine is not recommended for treatment 2

For Skin Manifestations

• Moisturizing creams such as urea cream/ointment for hand and foot lesions 1
• Avoid friction and heat exposure to affected areas 1
• Treat any secondary bacterial infections that may develop 1

What Not To Do

• Antiviral treatment is not available for routine HFMD cases 2
• Antibiotics are not indicated unless there is evidence of secondary bacterial infection 1

Special Considerations

Severe Cases

• In rare severe cases (particularly with EV-71), patients may develop neurological complications such as encephalitis/meningitis or cardiopulmonary complications 1, 3
• Severe cases may require hospitalization for supportive care and monitoring 4
• Intravenous immunoglobulin should be considered for severe/complicated HFMD cases 4

Prevention

• Hand hygiene is the most important preventive measure, with thorough handwashing with soap and water being more effective than alcohol-based sanitizers 1
• Environmental cleaning, particularly of toys and objects that may be placed in children's mouths 1
• Children with HFMD should avoid close contact with others until fever resolves and mouth sores heal 1
• No vaccine is currently available for HFMD 3

Duration and Prognosis

• Most cases resolve within 7-10 days without complications 2
• In some cases, nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptoms 5
• Complete recovery is expected in most cases, even in adults who contract the disease 6