Approach Considerations
Usually, no medical care is necessary for hand-foot-and-mouth disease (HFMD), as most cases are mild. Exceptions include some serious complications from enterovirus 71 infections. Vaccines are in development and being matched to prevalent strains. [27, 28]
Research from China in 2012 shows that geraniin, a form of a tannin separated from the geranium plant, effectively inhibited virus replication in rhabdomyosarcoma cells with an IC50 (concentration that inhibits 50%) of 10 μg/mL. Moreover, geraniin treatment of mice that were challenged with a lethal dose of enterovirus 71 resulted in a reduction of mortality, relieved clinical symptoms, and inhibited virus replication in muscle tissues. The results suggest that geraniin may be used as a potential drug for treatment of enterovirus 71 infection. [29]
Research also shows lycorine may be a potential drug candidate for the clinical treatment of enterovirus 71–infected patients. Lycorine treatment of mice challenged with a lethal dose of enterovirus 71 resulted in reduction of mortality, clinical scores, and pathological changes in the muscles of mice, which were achieved through inhibition of viral replication. When mice were infected with a moderate dose of enterovirus 71, lycorine treatment was able to protect them from paralysis. [30]
Topical disinfectants show varied ability to inactivate the virus to prevent transmission. [31]
A case report of severe HFMD from enterovirus infection in an immunocompromised patient described a faster resolution of symptoms and lesions with oral acyclovir. [32]
Low-level laser therapy has also been shown to shorten the duration of painful oral ulcers. [33]
Outpatient care
For symptomatic pain control for oral ulcers associated with HFMD, elixirs such as diphenhydramine (Benadryl), aluminum and magnesium hydroxide (Mylanta), and sucralfate (Carafate) can be helpful. Several times daily, the patient should swish the elixir in his or her mouth and spit it out.
The application of topical viscous lidocaine with a cotton-tipped swab several times daily can help in controlling the pain caused by oral ulcers.
Prevention
Studies from China have shown that most of the children with hand-foot-and-mouth disease (HFMD) presented with vitamin A insufficiency, which was associated with their reduced immunity and more severe illness. [34]
Studies of large outbreaks of childhood HFMD in China have shown that risk factors for HFMD included playing with neighborhood children, visiting an outpatient medical clinic for another reason, and community exposures to crowded places. In this study, good hand-washing techniques by preschool-aged children and their caregivers had a significant protective effect against community-acquired HFMD from human enterovirus 71 infection. [35]
In a study of a large pediatric outbreak due to enterovirus 71 in China, several factors were studied to see which were predictive of increased severity in HFMD. Prior Epstein-Barr virus exposure, enterovirus 71 infection, and rural residence were associated with severe infections, while breastfeeding was a protective factor. [36]
Topical disinfectants show varied ability to inactivate the virus to prevent transmission. [31]
On December 3, 2015, the China Food and Drug Administration approved the first inactivated enterovirus 71 whole virus vaccine for prevention of severe HFMD. However, it is still not widely available commercially worldwide. [37]
A study in 2015, looking at disinfectants to halt the spread of HFMD viruses, tested 13 commercially available products. The results showed acidic ethanol disinfectants, alkaline cleaners, and sodium hypochlorite were very effective. Neutral ethanol disinfectants, hand soaps, and quaternary ammonium compound sanitizers did not show great effect against HFMD viruses. [38]
In 2020, a report from China demonstrated the clinical (real-world) effectiveness of three vaccines against enterovirus A71 in prevention of severe HFMD. [39] The risk of for enterovirus A71 infection in children aged 6-36 months was reduced by use of the vaccine. The inactivated vaccines performed well in severe HFMD.
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The lower lip has an ulcer with an erythematous halo.
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The tongue has an ulcer with an erythematous halo.
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A typical cutaneous lesion has an elliptical vesicle surrounded by an erythematous halo. The long axis of the lesion is oriented along the skin lines.
