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Acyclovir in the treatment of hand-foot-and-mouth disease
W B Shelley1, M Hashim, E D Shelley
1Department of Medicine, Medical College of Ohio, Toledo 43699-0008, USA.
Insights
Oral acyclovir rapidly improved symptoms and cleared lesions in patients with hand-foot-and-mouth disease. This antiviral treatment shows promise, potentially by boosting the body's natural interferon response against the Coxsackie A16 virus.
Area of Science:
- Virology
- Dermatology
- Pediatrics
Background:
- Hand-foot-and-mouth disease (HFMD) is a common viral illness, typically caused by Coxsackie A16 virus.
- HFMD presents with characteristic lesions on the hands, feet, and mouth, often accompanied by fever.
- Current treatment focuses on symptom management, with limited specific antiviral therapies.
Purpose of the Study:
- To evaluate the efficacy of oral acyclovir in treating hand-foot-and-mouth disease.
- To assess the speed of symptom resolution and lesion involution with acyclovir therapy.
- To explore potential mechanisms of action for acyclovir in HFMD, given the virus's known enzyme profile.
Main Methods:
- A cohort of twelve children and one adult with confirmed HFMD received oral acyclovir within 1-2 days of rash onset.
- Treatment duration was five days.
- Clinical observations included symptomatic relief, fever reduction (defervescence), and lesion changes.
Main Results:
- Rapid symptomatic relief and defervescence were observed within 24 hours of initiating acyclovir.
- Significant involution of palmar, plantar, and oral lesions occurred within 24 hours.
- Lesions were virtually resolved by the end of the five-day treatment course.
Conclusions:
- Oral acyclovir demonstrated significant therapeutic benefits in patients with hand-foot-and-mouth disease.
- The rapid improvement suggests acyclovir may enhance the host's interferon response, as Coxsackie A16 lacks the target enzyme for direct acyclovir inactivation.
- Further research is warranted to elucidate the precise mechanism of action and confirm acyclovir's role in HFMD management.
Abstract:
Twelve children ages 1 to 5 years and one adult with hand-foot-and-mouth disease were treated with oral acyclovir within one to two days of onset of the rash. Symptomatic relief, defervescence, and significant involution of lesions were seen within twenty-four hours of initiating therapy. Acyclovir was continued for five days, by which time palmar, plantar, and oral lesions were virtually gone. Acyclovir is a molecule tailored to inactivate the thymidine kinase of the herpesvirus. Since the Coxsackie A16 virus causing hand-foot-and-mouth disease lacks this enzyme, the beneficial therapeutic effect must be explained on other grounds, possibly due to enhancement of the antiviral effect of the patient's own interferon.