Treatment for Hand, Foot, and Mouth Disease (HFMD)
Hand, foot, and mouth disease is a self-limited viral illness requiring only supportive care, as there are no approved antiviral agents for treatment. 1, 2
Primary Management Approach
The cornerstone of HFMD management is symptomatic treatment, as the disease typically resolves within 7-10 days without sequelae 2, 3. Treatment focuses on:
- Pain control for oral ulcers and skin lesions 2
- Hydration maintenance, particularly important given painful oral lesions that may limit intake 2
- Fever management with standard antipyretics 2
When to Escalate Care
While most cases are benign, severe or complicated HFMD warrants consideration of intravenous immunoglobulin (IVIG), which has been recommended by several national and international guideline committees 2. This is particularly relevant for:
- Enterovirus A71 infections, which carry higher complication rates than coxsackievirus A16 2
- Cases with neurological involvement (brainstem damage, neurogenic pulmonary edema) 2
- Myocardial impairment with circulatory failure 2
Important caveat: Children under 5 years are most commonly affected, but adult transmission can occur, particularly in immunocompetent household contacts 4.
Emerging Therapies (Not Yet Approved)
Several agents are under investigation but currently no specific antiviral agents are approved for HFMD treatment 2. Experimental candidates include ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline 2.
Prevention Strategies
- Good personal hygiene is the primary preventive measure 2
- Isolation of affected individuals to prevent outbreaks, given the highly contagious nature 4, 2
- Vaccination in high-risk areas where available 2
Atypical Presentations to Recognize
- Eczema coxsackium: In children with atopic dermatitis, coxsackievirus can superinfect eczematous skin, mimicking herpes infection 1
- Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset 5, 1
Critical pitfall: Do not confuse HFMD with hand-foot syndrome (HFS) or hand-foot skin reaction (HFSR) from chemotherapy agents—these are entirely different conditions requiring different management approaches 6.