What are the management strategies for hand foot mouth disease?

Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) management should focus on supportive care measures, including pain relief, hydration, and prevention of spread, as the condition is typically self-limiting and resolves within 7-10 days without specific antiviral treatment. 1, 2

Clinical Features and Diagnosis

• HFMD is caused by human enteroviruses, most commonly coxsackieviruses A6, A10, A16, and enterovirus 71, with EV-A71 associated with more severe outbreaks, particularly in Asia 1, 3
• Typical 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 primarily clinical, though RT-PCR testing of vesicle fluid samples, respiratory samples, or stool specimens can confirm the diagnosis when necessary 1
• The differential diagnosis includes erythema multiforme, herpes, measles, and varicella 2

Management Strategies

Supportive Care

• Oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 1, 2
• Ensure adequate hydration, particularly when oral ulcers make drinking painful 2, 5
• Avoid spicy, acidic, or hot foods and beverages that may exacerbate oral pain 1
• Mild toothpaste and gentle oral hygiene for management of oral lesions 1

Skin Care

• Intensive skin care of hands and feet with moisturizing creams, particularly urea-containing products 6, 1
• Avoid friction and heat exposure to affected areas 6, 1
• Treatment of any secondary bacterial infections that may develop 1

What to Avoid

• Oral lidocaine is not recommended for pain management 2
• No specific antiviral treatment is currently approved for routine use in HFMD 2, 3
• Chemical agents or plasters to remove any associated corns or calluses should not be used 6

Special Considerations

• Monitor for rare but serious complications, particularly with EV-71 infections, including:
  • Neurological complications (encephalitis, meningitis, acute flaccid myelitis) 1, 5
  • Cardiopulmonary complications 3, 5
• Immunocompromised patients may experience more severe disease and should be monitored closely 1
• Nail changes, including shedding (onychomadesis), may occur up to two months after initial symptoms 3, 7

Prevention and Control

• 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 can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present 1
• Avoid sharing utensils, cups, or food to prevent spread 1

Atypical Presentations

• Children with atopic dermatitis may present with "eczema coxsackium," where eczematous skin is superinfected with coxsackievirus, resembling herpes infection 7
• Some outbreaks, particularly those caused by coxsackievirus A6, may affect adults and present with more severe symptoms than classic HFMD 3

Treatment for Severe Cases

• Intravenous immunoglobulin should be considered for severe/complicated HFMD cases, particularly those with neurological involvement 5
• Mechanical ventilation may be required in cases with severe respiratory symptoms 3

By following these management strategies, most cases of HFMD will resolve without complications, though careful monitoring for the rare severe manifestations is important, particularly in outbreaks associated with enterovirus 71.