What is the recommended treatment for hand, foot, and mouth disease (HFMD) in a diabetic patient?

Treatment for Hand, Foot, and Mouth Disease in a 58-Year-Old Diabetic Female

Treatment for hand, foot, and mouth disease (HFMD) in a diabetic patient should focus on supportive care, with emphasis on hydration, pain management with acetaminophen or ibuprofen, and careful foot inspection and care to prevent complications.

Disease Overview and Clinical Presentation

• HFMD is a common viral syndrome caused by human enteroviruses and coxsackieviruses, characterized by low-grade fever, maculopapular or papulovesicular rash on hands and feet, and painful oral ulcerations 1
• Lesions typically resolve in 7-10 days without specific antiviral treatment 1
• Transmission occurs through fecal-oral, oral-oral, and respiratory droplet contact 1

Management Approach for Diabetic Patients

Immediate Treatment Recommendations

• Provide supportive care focused on hydration and pain relief with acetaminophen or ibuprofen as needed 1
• Avoid oral lidocaine as it is not recommended for HFMD 1
• Monitor blood glucose levels closely as infections can affect glycemic control in diabetic patients 2

Foot Care Considerations (Critical for Diabetic Patients)

• Perform daily foot inspection to identify any pre-ulcerative signs or complications of the HFMD lesions 2
• Wash feet daily with careful drying, particularly between toes 2
• Apply emollients to lubricate dry skin but avoid applying between toes 2
• Avoid walking barefoot, in socks only, or in thin-soled slippers to protect feet 2

Prevention of Diabetic Foot Complications

• Ensure proper footwear that fits correctly - internal width should equal the width of the foot at the metatarsal phalangeal joints 2
• For patients with neuropathy, use well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure 2
• Treat any pre-ulcerative signs promptly, including removing callus, protecting blisters, and treating fungal infections 2
• Consider specialized therapeutic footwear for high-risk diabetic patients with severe neuropathy or foot deformities 2

Infection Control and Monitoring

• Handwashing and disinfecting potentially contaminated surfaces are essential to prevent spread 1
• Monitor for rare neurologic or cardiopulmonary complications, which require immediate medical attention 1
• If any signs of secondary bacterial infection develop in foot lesions, obtain cultures and initiate appropriate antibiotic therapy 2
• For moderate to severe secondary infections, consider systemic antibiotics for 1-2 weeks 2

Special Considerations for Older Diabetic Patients

• Assess for peripheral neuropathy and peripheral arterial disease, which are common in long-standing diabetes and may complicate healing 2
• Perform a comprehensive foot evaluation including inspection of skin, assessment of foot deformities, neurological assessment (10-g monofilament testing), and vascular assessment 2
• If the patient has evidence of sensory loss, inspect feet at every follow-up visit until HFMD resolves 2
• Maintain tight glucose control to reduce risk of complications, as hyperglycemia can impair immune function and wound healing 3

Follow-up Care

• Schedule follow-up within 1-2 weeks to ensure resolution of symptoms and absence of complications 2
• Consider referral to a foot care specialist if the patient has history of prior lower-extremity complications, loss of protective sensation, or peripheral arterial disease 2
• Provide education on foot self-care and signs of worsening infection that require immediate medical attention 2

Remember that while HFMD is typically self-limited, the diabetic status of the patient requires extra vigilance to prevent complications that could lead to significant morbidity.