What are the treatment and prevention options for foot and mouth disease?

Hand, Foot, and Mouth Disease: Treatment and Prevention

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness requiring only supportive care with oral analgesics and hydration, as no specific antiviral treatment exists for this condition. 1, 2

Clinical Recognition

HFMD presents with:

• Low-grade fever followed by painful oral ulcerations and a maculopapular or papulovesicular rash on hands and feet 2
• Incubation period of 3-10 days before symptom onset 3
• Spontaneous resolution in 7-10 days in most cases 2, 4
• Enterovirus 71 (EV-A71) causes more severe outbreaks with potential neurological complications including encephalitis, meningitis, and acute flaccid paralysis 1, 5

Critical distinction: This is NOT the same as foot-and-mouth disease in livestock, which is caused by a completely different virus affecting cloven-hoofed animals 6

Treatment Algorithm

Symptomatic Management

• Use acetaminophen or NSAIDs for pain relief and fever reduction (limited duration) 1
• Avoid oral lidocaine - not recommended for oral lesions 2
• No antiviral therapy available for routine HFMD 2, 3

Oral Lesion Care

• Apply white soft paraffin ointment to lips every 2 hours to prevent drying 1
• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating 1
• Chlorhexidine oral rinse twice daily as antiseptic 1
• Clean mouth with warm saline mouthwashes or oral sponge 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1

Skin Lesion Management

• Apply intensive moisturizing creams (urea-containing products) to hands and feet 1
• Use zinc oxide 20% for itchiness - provides protective barrier and achieved 50% clearance in trials 1
• Apply zinc oxide in thin layer after gentle cleansing; can use with loose cotton gloves at night for enhanced effect 1
• Avoid friction and heat exposure to affected areas 1

Management of Open Foot Sores

• Wash feet daily with careful drying between toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear 1
• Do not soak feet - induces maceration and worsens open sores 1
• Monitor for secondary infection signs: increased redness, warmth, purulent drainage, or worsening pain 1
• Reassess after 2 weeks if lesions not improving 1

Severe Cases (EV-71 with complications)

• Intravenous immunoglobulin should be considered for severe/complicated HFMD 4
• Mechanical ventilation may be needed for respiratory complications 3
• Ribavirin has been used in severe cases, though not generally recommended 3

Prevention Strategies

Primary Prevention

• Hand hygiene is the most important measure - thorough handwashing with soap and water is more effective than alcohol-based sanitizers 1
• Environmental cleaning of 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 resolves and mouth sores heal, even if skin rash persists 1
• Exclusion based solely on healing skin lesions is unnecessary 1
• By diagnosis time, the child has likely been infectious for weeks, posing limited additional risk 1

High-Risk Populations

• Immunocompromised patients require close monitoring as they may experience more severe disease 1

Diagnostic Confirmation

When needed:

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

Critical Pitfalls to Avoid

• Do not confuse with herpes simplex virus - HSV has antiviral treatment options while HFMD does not 1
• Never 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
• Avoid applying zinc oxide to open or weeping lesions 1
• If symptoms persist beyond 4 weeks, re-evaluate and consider alternative diagnoses 1