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

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

The treatment for Hand, Foot, and Mouth Disease (HFMD) in adults is primarily supportive care, as it is typically a self-limited viral illness that resolves within 7-10 days without specific antiviral therapy. There is no role for tornado and dexamethasone in the standard management of HFMD.

Clinical Presentation and Diagnosis

• HFMD is characterized by fever, oral ulcers, and skin manifestations affecting the palms, soles, and buttocks, with symptoms usually lasting less than 1 week 1
• The disease is highly infectious and commonly caused by enteroviruses, particularly coxsackieviruses and enterovirus A71 (EV-A71) 2
• Adults may present with more subtle symptoms than children, but can still develop the classic triad of oral vesicles, maculopapular lesions on hands and feet 3

Standard Treatment Approach

Supportive Care (First-line)

• Adequate hydration and nutrition despite oral discomfort 4
• Antipyretics for fever management (acetaminophen or ibuprofen) 2
• Topical oral anesthetics may help relieve pain from oral lesions 1
• Rest until symptoms resolve 3

Monitoring

• Most cases resolve within 7-10 days without specific treatment 1
• Monitor for rare but serious complications, particularly with EV-A71 infections 2

Management of Complications

Neurological Complications

• Severe cases with neurological involvement (encephalomyelitis) may benefit from intravenous immunoglobulin (IVIG) therapy 5
• A case report of a 21-year-old woman with EV-A71-induced encephalomyelitis showed full recovery after a single dose of IVIG therapy 5

Cardiopulmonary Complications

• Rare but potentially fatal cardiopulmonary complications require intensive supportive care 4
• These complications are more commonly associated with EV-A71 infections 2

Important Considerations

• There is no evidence supporting the use of corticosteroids like dexamethasone for uncomplicated HFMD 2, 4
• "Tornado" is not a recognized medical treatment for HFMD in any clinical guidelines
• No specific antiviral medications are currently approved for HFMD 4
• The case severity rate has been estimated at 1%, with a case fatality rate at 0.03%, primarily in cases involving EV-A71 2

Prevention

• Hand hygiene and avoiding close contact with infected individuals 3
• In China, an inactivated EV-A71 vaccine has shown high protection against EV-A71-related HFMD, but is not available worldwide 4

Follow-up

• Monitor for delayed cutaneous manifestations such as onychomadesis (nail shedding) and acral desquamation which may occur weeks after the acute illness 2
• Most adults recover completely without sequelae 3

While HFMD is typically more common in children, adults can develop the disease with similar presentations. The standard of care focuses on symptomatic treatment rather than specific antiviral therapy, corticosteroids, or other interventions that lack evidence of benefit.