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

Treatment of Hand, Foot, and Mouth Disease

The treatment of hand, foot, and mouth disease is primarily supportive care focused on symptom relief, including acetaminophen or NSAIDs for pain and fever, adequate hydration, and gentle oral hygiene. 1, 2

Clinical Features and Diagnosis

• Hand, foot, and mouth disease (HFMD) is a common viral illness caused by enteroviruses, primarily affecting children under 5 years of age 3, 2
• Classic presentation includes low-grade fever, painful oral ulcerations, and maculopapular or papulovesicular rash on the hands and soles of the feet 2, 4
• Diagnosis is typically clinical, though RT-PCR testing of vesicle fluid samples, respiratory samples, or stool specimens can confirm the diagnosis 1
• Most cases resolve spontaneously within 7-10 days without complications 2, 5

Treatment Approach

Supportive Care

• Oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 1, 2
• Ensure adequate hydration, especially important when oral lesions make drinking painful 1, 2
• Mild toothpaste and gentle oral hygiene to manage oral lesions 1
• Cold foods like popsicles or ice cream may provide temporary relief for oral pain 2
• Avoid spicy, acidic, or hot foods and beverages that may irritate oral lesions 1

Management of Specific Symptoms

For Oral Lesions/Stomatitis

• Early intervention for oral lesions is recommended 1
• For severe oral ulcers, consider delaying normal activities until symptoms resolve 1
• Oral lidocaine is NOT recommended for pain relief 2

For Skin Manifestations

• Intensive skin care of hands and feet with moisturizing creams, such as urea cream/ointment 1
• Avoid friction and heat exposure to affected areas 1
• Monitor for and treat any secondary bacterial infections that may develop 1

Special Considerations

• Immunocompromised patients may experience more severe disease and should be monitored closely 1
• Rare complications can include neurologic (encephalitis, meningitis) or cardiopulmonary issues, particularly with Enterovirus 71 infections 5, 6
• Nail changes such as shedding may occur weeks after initial symptoms 3, 4

Prevention

• Hand hygiene is the most important preventive measure, with thorough handwashing with soap and water being 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, 2
• No specific antiviral treatment is currently available for HFMD 2, 5
• Intravenous immunoglobulin may be considered for severe/complicated cases 5

When to Return to School/Daycare

• Children can typically return to school or daycare once fever has resolved and mouth sores have healed, or as directed by local health department guidelines 1
• Standard precautions and good hand hygiene practices should be followed in all settings 1