What is the treatment approach for hand, foot, and mouth disease (HFMD)?

Treatment Approach for Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is primarily managed with supportive care focused on hydration and pain relief with acetaminophen or ibuprofen, as the condition is typically self-limited and resolves within 7-10 days without specific antiviral treatment. 1

Disease Overview

• HFMD is a common viral illness caused by enteroviruses (primarily coxsackievirus A16 and enterovirus A71) that predominantly affects children under 5 years of age 1, 2
• The disease is characterized by fever, painful oral ulcerations, and a maculopapular or papulovesicular rash on the hands and feet 1
• HFMD is highly contagious and transmitted through fecal-oral, oral-oral, and respiratory droplet contact 1
• Most cases are mild and self-limiting, but rare neurological or cardiopulmonary complications can occur, particularly with EV-A71 infections 3, 4

Treatment Recommendations

Supportive Care (First-line Management)

• Provide adequate hydration to prevent dehydration, especially when oral ulcers make drinking painful 5
• Administer oral analgesics such as acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 5
• Avoid oral lidocaine as it is not recommended for HFMD management 1

Management of Specific Symptoms

For Oral Lesions

• Use mild toothpaste and gentle oral hygiene to manage oral lesions 5
• Consider cold foods, ice pops, or cold beverages to soothe oral pain 5
• For severe oral ulcers (>grade 2), consider delaying normal activities until symptoms resolve 5

For Skin Manifestations

• Apply moisturizing creams, particularly urea-containing products, to affected hands and feet 5
• Avoid friction and heat exposure to affected areas 5
• Monitor for and treat any secondary bacterial infections that may develop 5

Special Considerations

Severe Cases

• Intravenous immunoglobulin should be considered for severe/complicated HFMD, particularly with neurological complications 3
• Monitor closely for signs of neurological involvement (encephalitis, meningitis, acute flaccid myelitis) or cardiopulmonary complications, especially in cases caused by EV-A71 5, 4
• Immunocompromised patients may experience more severe disease and should be monitored closely 5

Return to Daycare/School Guidelines

• Children can return to daycare once fever has resolved and mouth sores have healed 5
• Exclusion based solely on healing skin lesions is not necessary 5

Prevention Measures

• Hand hygiene is the most important preventive measure, with thorough handwashing with soap and water being more effective than alcohol-based hand sanitizers 5
• Environmental cleaning, particularly of toys and objects that may be placed in children's mouths 5
• Avoid sharing utensils, cups, or food 5
• Children with HFMD should avoid close contact with others until fever resolves and mouth sores heal 5

Common Pitfalls to Avoid

• Do not use oral lidocaine for pain management as it is not recommended and may mask the gag reflex 1
• Avoid chemical agents or plasters to remove any associated corns or calluses 5
• Do not delay seeking medical attention if neurological symptoms (such as lethargy, irritability, or limb weakness) develop, as these may indicate serious complications 3, 4
• Remember that antiviral treatment is not currently available for routine HFMD cases 1