From the Research
Corticosteroids are generally not recommended for the routine treatment of hand, foot, and mouth disease (HFMD). HFMD is typically a self-limiting viral illness caused primarily by enteroviruses (especially Coxsackievirus A16 and Enterovirus 71) that resolves on its own within 7-10 days without specific treatment. Treatment should focus on supportive care to manage symptoms, including acetaminophen or ibuprofen for fever and pain, adequate hydration (especially if mouth sores make drinking difficult), and soft, cold foods that don't irritate mouth ulcers.
Key Points to Consider
- Corticosteroids like prednisone or dexamethasone have not been proven effective for uncomplicated HFMD and may potentially suppress the immune response needed to fight the viral infection 1.
- In rare severe cases with complications such as encephalitis, myocarditis, or pulmonary edema (more commonly associated with EV71 infections), corticosteroids might be considered under specialist supervision in a hospital setting, but this represents the exception rather than standard care.
- The rationale for avoiding steroids in routine cases is that HFMD is viral in nature, and the potential risks of immunosuppression from steroids outweigh any potential anti-inflammatory benefits for a disease that typically resolves without complications.
- A recent study from 2023 found that suppression of innate and acquired immunity in severe hand foot and mouth disease caused by EV71 infections in children, which suggests that immunosuppressive treatments like corticosteroids could be harmful 2.
- Another study from 2023 discussed the current status of hand-foot-and-mouth disease, highlighting the importance of understanding the disease's virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development to improve clinical practices and public health efforts, but did not support the routine use of corticosteroids 3.
Recommendation
Based on the most recent and highest quality evidence, the use of corticosteroids is not recommended for routine treatment of HFMD. Instead, treatment should focus on supportive care to manage symptoms and prevent complications. In severe cases, corticosteroids may be considered under specialist supervision, but this should be done with caution and careful consideration of the potential risks and benefits.