What is the treatment and management for foot and mouth disease (HFMD) in humans and animals?

Treatment and Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limiting viral illness that requires supportive care only, with treatment focused on pain relief, hydration, and monitoring for rare neurological complications. 1

Supportive Care Measures

Pain and Fever Management

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and oral pain 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 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
• Use chlorhexidine oral rinse twice daily as an antiseptic measure 1
• Practice mild oral hygiene with gentle toothpaste 1

Skin Manifestations Management

• Apply intensive skin care to hands and feet with moisturizing creams, particularly urea-containing products 1
• Use zinc oxide as a protective barrier on itchy skin lesions, applying in a thin layer after gentle cleansing 1
• Avoid friction and heat exposure to affected areas 1
• Do not use chemical agents or plasters to remove corns or calluses 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 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

Prevention and Infection Control

Hand Hygiene

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

Environmental Measures

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

Isolation Guidelines

• Children should avoid close contact with others until fever resolves and mouth sores heal 1
• 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, as by the time HFMD is diagnosed, the child has likely had the infection for weeks 1

Monitoring for Complications

Neurological Complications

• Watch for signs of meningoencephalitis or brainstem encephalitis, which contribute 70% of all neurological complications 2
• Monitor for fever, vomiting, myoclonic jerks, seizures, headache, and convulsions 2
• Enterovirus 71 (EV-A71) is associated with more severe outbreaks and neurological complications, especially in Asia 1, 3
• Rare complications include acute flaccid myelitis and acute flaccid paralysis 1

Immunocompromised Patients

• These patients may experience more severe disease and require closer monitoring 1

Follow-Up Timing

• Reassess after 2 weeks if lesions are not improving with standard care 1
• If evidence of infection has not resolved after 4 weeks, re-evaluate and consider alternative diagnoses 4

Important Diagnostic Distinction

It is crucial to distinguish HFMD from herpes simplex virus, as HSV has available antiviral treatment options whereas HFMD does not 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics for uncomplicated HFMD, as it is a viral illness 3, 5
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions 1
• Do not treat secondary bacterial infections unless clear signs of bacterial superinfection are present 1
• Avoid applying zinc oxide to open or weeping lesions 1

Special Considerations

• Most HFMD cases are mild and self-limiting, resolving within a few days without complications 3, 6
• The disease is highly contagious and spreads by fecal-oral, oral-oral, and respiratory droplet contact 6
• Active communication and close monitoring are integral to managing HFMD without complications 6
• There is currently no specific pharmaceutical intervention or widely available vaccine for HFMD outside of China 3, 7