What is the management approach 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 practicing good hand hygiene to prevent spread. 1, 2

Supportive Care Measures

Pain and Fever Management

• Administer oral acetaminophen or NSAIDs for pain relief and fever reduction for a limited duration 1
• Avoid oral lidocaine, as it is not recommended for HFMD 2
• No antiviral treatment is available or indicated for HFMD 2

Oral Lesion Management

• Apply white soft paraffin ointment to lips every 2 hours to prevent drying and cracking 1
• Use warm saline mouthwashes or oral sponges for daily mouth cleaning 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
• Maintain gentle oral hygiene with mild toothpaste 1

Skin Manifestations (Hand and Foot Lesions)

• Apply intensive moisturizing care with urea-containing creams to hands and feet 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; avoid application to open or weeping lesions 1

Management of Open Sores on Feet

• Wash feet daily with careful drying, particularly between the toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect lesions 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens 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

Hydration Support

• Ensure adequate fluid intake, as painful oral lesions may reduce oral intake 2, 3
• The disease typically resolves in 7-10 days without complications 2, 3

Prevention and Infection Control

Hand Hygiene (Most Important)

• Handwashing with soap and water is more effective than alcohol-based hand sanitizers and represents the most important preventive measure 1
• Disinfect potentially contaminated surfaces, toys, and objects that may be placed in children's mouths 1

Isolation Precautions

• 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
• Avoid sharing utensils, cups, or food 1
• Follow standard precautions and good hand hygiene practices in healthcare settings 1

Diagnostic Confirmation (When Needed)

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

Red Flags Requiring Close Monitoring

• Immunocompromised patients may experience more severe disease and require close monitoring 1
• Watch for neurological complications (encephalitis/meningitis, acute flaccid myelitis, acute flaccid paralysis), particularly with Enterovirus 71 1
• Monitor for cardiopulmonary complications in severe cases 2, 3

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 corns or calluses 1
• Do not confuse HFMD with herpes simplex virus, which has antiviral treatment options, whereas HFMD does not 1
• Reassess after 2 weeks if lesions are not improving with standard care 1