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

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

Hand, Foot, and Mouth Disease should be managed with supportive care measures, including acetaminophen or NSAIDs for pain and fever, adequate hydration, and oral hygiene, as there is no specific antiviral treatment available. 1

Diagnosis and Clinical Features

• HFMD is a viral illness primarily affecting children under 5 years of age, characterized by oral herpes and rashes on the hands and feet 2
• Vesicle fluid samples have high viral loads and are ideal for testing, with reverse transcriptase PCR (RT-PCR) being the preferred diagnostic method 1
• Respiratory samples and stool specimens can also be used for diagnosis 1
• Enterovirus 71 (EV-A71) is associated with more severe outbreaks, especially in Asia, while coxsackievirus A16 has traditionally been the most common cause in the US 1, 3

Treatment Approach

Supportive Care (First-line Management)

• Oral analgesics such as acetaminophen or NSAIDs are recommended for pain relief and fever reduction 1
• Ensure adequate hydration, especially when oral lesions make drinking painful 1
• Mild toothpaste and gentle oral hygiene are recommended to manage oral lesions 1
• Intensive skin care of hands and feet with moisturizing creams (e.g., urea cream/ointment) is recommended 1
• Avoid friction and heat exposure to affected areas 1

Management of Specific Symptoms

• For oral lesions/stomatitis:

  • Early intervention is recommended 1
  • Consider delaying normal activities until symptoms resolve for severe oral ulcers (>grade 2) 1
  • Cold foods and beverages may provide relief for oral discomfort 1

• For skin manifestations:

  • Apply moisturizing creams to affected areas 1
  • Monitor for and treat any secondary bacterial infections that may develop 1

Special Considerations

Severe Cases

• Monitor closely for signs of neurological complications, particularly in:

  • Children under 3 years of age 4
  • Cases with disease duration less than 3 days 4
  • EV-A71 infections 4

• Warning signs of possible deterioration include:

  • Persistent high fever 4
  • Neurological symptoms (irritability, lethargy, myoclonic jerks) 4
  • Abnormal respiratory rate or rhythm 4
  • Circulatory dysfunction 4
  • Elevated white blood cell count 4
  • Elevated blood glucose 4
  • Elevated blood lactic acid 4

• Intravenous immunoglobulin should be considered for severe/complicated HFMD 5

Prevention and Control

• 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, is crucial 1
• Children with HFMD should avoid close contact with others until fever resolves and mouth sores heal 1
• Avoid sharing utensils, cups, or food to prevent spread 1

Return to Daycare Guidelines

• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present 1
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others 1

Prognosis

• Most cases resolve spontaneously within 7-10 days without complications 5
• Severe complications are rare but may include encephalitis, meningitis, acute flaccid paralysis, and pulmonary edema 3
• Nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptom onset 6

Common Pitfalls

• Failing to recognize potential severe cases early, particularly those caused by EV-A71 4
• Overlooking the need for close monitoring in children under 3 years of age 4
• Inadequate attention to hydration status when oral lesions make drinking painful 1
• Unnecessary exclusion from daycare based solely on healing skin lesions 1