Hand-Foot-and-Mouth Disease
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Hand-foot-and-mouth disease (HMFD) is a viral illness with oral and distal-extremity lesions. It is most commonly caused by coxsackievirus A16 and typically affects children and infants. HMFD is highly contagious during the first week of infection and may lead to epidemics from direct contact with nasal and oral secretions or fecal material. The incubation period typically averages 3-7 days.
Symptoms
Symptoms include fever, rash, headache, sore throat, oropharyngeal ulcers, and loss of appetite. The oral lesions are typically 2-3 mm vesicles on an erythematous base. Care is typically supportive with antipyretics and anesthetics for symptomatic relief on a case-by-case basis.
Physical findings
Physical findings include the following:
- Initially, macular lesions appear on the buccal mucosa, tongue, and/or hard palate
- These mucosal lesions rapidly progress to vesicles that erode and become surrounded by an erythematous halo
- Lesions may also be found on the hands, feet, buttocks, and genitalia
- A fever of 38-39°C may be present for 24-48 hours
Management
There is no antiviral agent specific for the etiologic agents of HFMD. Instead, the treatment is supportive, as follows:
- Ensure adequate fluid intake to prevent dehydration; cold liquids are generally preferable
- Spicy or acidic substances may cause discomfort
- Intravenous hydration may be necessary if the patient has moderate-to-severe dehydration or if discomfort precludes oral intake
- Fever may be treated with antipyretics
- Pain may be treated with standard doses of paracetamol or ibuprofen
- Direct analgesia may also be applied to the oral cavity via mouthwashes or sprays