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

Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, with treatment focused on pain relief using acetaminophen or NSAIDs, maintaining hydration, and implementing strict hand hygiene measures to prevent transmission. 1, 2

Symptomatic Treatment

Pain and Fever Management

• Oral analgesics such as acetaminophen or NSAIDs should be used for a limited duration to relieve pain and reduce fever. 1
• Avoid oral lidocaine as it is not recommended for HFMD. 2
• No specific antiviral treatment is available for HFMD. 2, 3

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 Manifestations 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 in a thin layer after gentle cleansing. 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier. 1
• Avoid applying zinc oxide to open or weeping lesions. 1

Foot Lesion Care (When Open Sores Present)

• Wash feet daily with careful drying, particularly between the toes. 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions. 1
• Do not soak feet in footbaths, as this can induce skin maceration and worsen open sores. 1
• Monitor for signs of secondary bacterial infection including increased redness, warmth, purulent drainage, or worsening pain. 1
• Treat any secondary bacterial infections that develop. 1

Prevention and Infection Control

Hand Hygiene (Most Important Measure)

• Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers and represents the single most important preventive measure. 1
• Standard precautions and good hand hygiene practices should be followed in healthcare settings. 1

Environmental Measures

• Clean and disinfect toys and objects that may be placed in children's mouths. 1, 2
• Disinfect potentially contaminated surfaces and fomites. 2
• 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
• Children should avoid close contact with others until fever resolves and mouth sores heal. 1

Monitoring and Follow-Up

Routine Cases

• Most cases resolve in 7-10 days without sequelae. 2, 3
• Reassess after 2 weeks if lesions are not improving with standard care. 1

Warning Signs Requiring Close Monitoring

• Immunocompromised patients may experience more severe disease and should be monitored closely. 1
• Watch for neurological complications such as encephalitis/meningitis, particularly with Enterovirus 71 (EV-A71). 1
• Monitor for rare complications including acute flaccid myelitis (AFM) and acute flaccid paralysis (AFP). 1
• Be alert for cardiopulmonary complications in severe cases. 2, 4

Diagnostic Considerations

When Laboratory Confirmation Needed

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

Important Differential Diagnosis

• Distinguish HFMD from herpes simplex virus, as the latter has available antiviral treatment options. 1
• Consider erythema multiforme, measles, and varicella in the differential diagnosis. 2

Common Pitfalls to Avoid

• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions. 1
• Do not use chemical agents or plasters to remove any associated corns or calluses. 1
• Do not prescribe oral lidocaine for pain management. 2
• Recognize atypical presentations in children with atopic dermatitis, including "eczema coxsackium" which may mimic herpetic superinfection. 5
• Consider antecedent HFMD when children present with nail changes (Beau's lines or nail shedding) weeks after initial symptoms. 5, 6