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

Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness requiring only supportive care with oral analgesics for symptom relief, good hand hygiene to prevent transmission, and monitoring for rare severe complications. 1

Symptomatic Treatment

Pain and Fever Management

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1
• These oral analgesics address the constitutional symptoms and discomfort from oral and skin lesions. 1

Oral Lesion Care

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort. 1
• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain. 1
• Use chlorhexidine oral rinse twice daily as an antiseptic measure. 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily. 1
• Use mild toothpaste and gentle oral hygiene practices. 1

Skin Manifestation Management

• Apply intensive skin care to hands and feet with moisturizing creams, particularly urea-containing products. 1
• Avoid friction and heat exposure to affected areas. 1
• For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing of affected areas. 1
• Apply zinc oxide in a thin layer and repeat as needed when itchiness returns. 1
• Avoid applying zinc oxide to open or weeping lesions. 1
• Do not use chemical agents or plasters to remove any associated corns or calluses. 1

Prevention and Infection Control

Hand Hygiene (Most Critical Measure)

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers and is the most important preventive measure. 1

Environmental Cleaning

• Clean toys and objects that may be placed in children's mouths. 1
• Avoid sharing utensils, cups, or food. 1

Isolation Guidelines

• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present. 1
• Exclusion based solely on healing skin lesions is not necessary. 1
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others. 1
• In healthcare settings, follow standard precautions and good hand hygiene practices. 1

Monitoring for Complications

High-Risk Features Requiring Close Observation

• Enterovirus 71 (EV-A71) is associated with more severe outbreaks, especially in Asia, and requires heightened vigilance. 1
• Immunocompromised patients may experience more severe disease and should be monitored closely. 1

Severe Complications to Watch For

• Neurological complications such as encephalitis/meningitis can occur in severe cases, particularly with EV-71. 1
• Acute flaccid myelitis (AFM) and acute flaccid paralysis (AFP) are rare but potential neurological complications. 1
• Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. 2

Treatment of Secondary Infections

• Treat any secondary bacterial infections that may develop. 1

Diagnostic Confirmation (When Needed)

• Vesicle fluid samples have high viral loads and are ideal for testing. 1
• Reverse transcriptase PCR (RT-PCR) targeting the 5′ non-coding region is the preferred diagnostic method due to its sensitivity and specificity. 1
• Respiratory samples and/or stool specimens can also be used for diagnosis with RT-PCR. 1

Common Pitfalls to Avoid

• Do not exclude children from daycare based solely on persistent skin lesions after fever and oral lesions have resolved. 1
• Do not rely solely on alcohol-based hand sanitizers; soap and water handwashing is superior for HFMD prevention. 1
• Be aware that widespread exanthema beyond the classic distribution (hands, feet, mouth) may occur, involving the legs and trunk, particularly with Coxsackievirus A6. 1, 3
• Onychomadesis (nail shedding) can occur up to two months after initial symptoms and is associated with Coxsackievirus A6. 4, 5