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

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

Hand, foot, and mouth disease should be managed with supportive care focused on symptom relief, including oral analgesics for pain and fever, adequate hydration, and appropriate skin and oral care. 1

Clinical Features and Diagnosis

• HFMD is a common viral illness primarily affecting children under 5 years of age, characterized by low-grade fever, painful oral ulcerations, and maculopapular or papulovesicular rash on the hands and soles of the feet 2
• The disease is caused by human enteroviruses, with coxsackieviruses being the most common causative agents in North America, while Enterovirus 71 (EV-A71) is associated with more severe outbreaks, particularly in Asia 1, 3
• Diagnosis is primarily clinical based on the characteristic presentation, though laboratory confirmation can be achieved through RT-PCR testing of vesicle fluid samples, respiratory samples, or stool specimens 1
• The rash may extend beyond the classic distribution to involve the legs and other body areas 1, 3

Management Approach

Supportive Care (First-line Treatment)

• Ensure adequate hydration, particularly important due to painful oral lesions that may limit fluid intake 1, 2
• Administer oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 1, 2
• For oral lesions:
  • Encourage mild toothpaste and gentle oral hygiene 1
  • Avoid acidic, spicy, or hot foods and beverages that may exacerbate pain 1, 4
  • Cold foods (popsicles, ice cream) may provide temporary relief 2, 4
• For skin manifestations:
  • Apply moisturizing creams (such as urea cream/ointment) to affected areas 1
  • Avoid friction and heat exposure to affected skin areas 1

Important Considerations

• Oral lidocaine is not recommended for pain management due to risk of numbing the gag reflex 2
• No specific antiviral treatment is currently approved or available for routine HFMD 2, 5
• Monitor for rare but serious complications, particularly with EV-A71 infections, including:
  • Neurological complications (encephalitis, meningitis, acute flaccid myelitis) 1, 6
  • Cardiopulmonary complications in severe cases 4, 6
• Most cases resolve spontaneously within 7-10 days without sequelae 2, 4

Prevention and Control

• Hand hygiene is the most important preventive measure:
  • Thorough handwashing with soap and water is more effective than alcohol-based hand 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
• Standard precautions should be followed in healthcare settings 1

Special Populations

• Children with atopic dermatitis may present with "eczema coxsackium," where eczematous skin is superinfected with coxsackievirus, resembling herpes infection 3
• Immunocompromised patients may experience more severe disease and should be monitored closely 1
• For severe cases, particularly those with neurological complications from EV-A71, intravenous immunoglobulin may be considered 4

Follow-up Considerations

• Nail changes, such as shedding, may follow HFMD after a latency period 3
• Most patients recover completely without long-term sequelae 2, 4
• In rare cases with neurological involvement, follow-up may be needed to monitor for potential long-term neurological sequelae 1, 6