Hand, foot and mouth disease
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- Hand, foot, and mouth disease (HFMD) is an acute viral illness (most commonly due Coxsackie virus) characterised by lesions in the mouth, hands and feet
- Early symptoms (prodromal) which can last for a day or two include fever, malaise, loss of appetite, cough, abdominal pain, and sore mouth/throat. The vesicular lesions of the oral cavity occur within 1–2 days and become shallow ulcers surrounded by a erythematous ring. Typically, the macules and papules of the hands and feet — including the palms and soles — present after the oral lesions. Other areas of the body can also be affected such as the buttocks and groin
- It commonly affects children under 10 years of age, and particularly those younger than 4. Indeed, outbreaks have been reported among groups of children attending childcare facilities and schools
Referral criteria
- Signs and symptoms of dehydration
- Secondary bacterial infection of the lesions
- Presence of neurological features or complications including encephalitis and meningitis
Time frame to resolution
- It is usually a mild and self-limiting disease. The lesions appear a few days after prodromal symptoms; they last around 7 to 10 days and normally spontaneously resolve
Management strategy
Non-pharmacological advice
- Infection control measures are required to limit the spread, particularly immediately before and during the acute stage of the illness. It is spread in various ways, which therefore affects advice provisison ie. by nasal and throat secretions, vertical transmission from mother to child, contact with vesicle fluid and via the faecal-oral route (even when asymptomatic, the virus may still be excreted in faeces for a month or two after the onset of the illness)
- Provide reassurance that it is normally a mild, self-limiting illness which is unrelated to 'foot and mouth disease' (of animals) but also what warning signs to look out for (see under Referral criteria)
- Ensure adequate fluid intake (particularly if a fever is present) and soft foods (which are not salty or spicy) may be helpful if mouth lesions are sore
Pharmacological advice
- Paracetamol or ibuprofen may be useful for symptomatic relief of painful lesions