What are the recommended topical treatments for hand, foot, and mouth disease (coxsackie)?

Topical Treatments for Hand, Foot, and Mouth Disease (Coxsackie)

There are no specific recommended topical treatments for hand, foot, and mouth disease, and management should focus on supportive care including pain relief with acetaminophen or ibuprofen rather than topical medications.

Understanding Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a common viral illness caused by enteroviruses, primarily coxsackieviruses. It typically affects children under 10 years of age but can occasionally affect adults 1, 2. The disease is characterized by:

• Low-grade fever
• Painful oral ulcerations
• Maculopapular or papulovesicular rash on hands and soles of feet
• Self-limiting course that typically resolves in 7-10 days

Evidence-Based Management Approach

First-Line Treatment: Supportive Care

1. Systemic pain relief:

   • Acetaminophen or ibuprofen as needed for pain and fever 1
   • Dosing should follow standard pediatric or adult guidelines

2. Hydration:

   • Encourage fluid intake
   • Cold liquids, popsicles, or ice cream may help soothe oral pain

Topical Treatments: Limited Evidence and Not Recommended

Current evidence does not support the use of specific topical treatments for HFMD:

• Topical antibiotics: Not recommended as HFMD is viral in nature 3
• Topical antiseptics: No evidence supporting benefit for viral infections like HFMD 3
• Oral lidocaine: Explicitly not recommended for HFMD 1
• Silver preparations or honey: No evidence supporting their use for HFMD 3

Mouth Care Considerations

While specific topical treatments aren't recommended for HFMD, general mouth care principles that might provide comfort include:

• Warm saline mouthwashes for cleansing
• Avoiding spicy, acidic, or hot foods that may irritate oral lesions
• Soft, bland diet while oral lesions are present

Special Considerations

When to Seek Medical Attention

Patients should seek medical attention if:

• Signs of dehydration develop
• Fever persists beyond 3-4 days
• Neurologic symptoms develop (rare complications)
• Symptoms worsen significantly after 3-4 days

Prevention of Spread

The most effective preventive measures include:

• Handwashing with soap and water
• Disinfecting potentially contaminated surfaces and fomites 1
• Children are particularly infectious until blisters have disappeared 2

Common Pitfalls to Avoid

1. Misdiagnosis: HFMD can be confused with other conditions including herpes, erythema multiforme, measles, and varicella 1, 4

2. Inappropriate medication use: Prescribing antibiotics or antiviral medications is not indicated as they are ineffective against enteroviruses 1, 5

3. Unnecessary exclusion policies: Complete exclusion from school or childcare may not be practical as the virus can persist in feces for several weeks 2

4. Overlooking hydration: Oral pain may lead to decreased fluid intake, making hydration a priority

5. Using topical oral anesthetics: These may provide temporary relief but are not recommended due to potential side effects and lack of evidence for HFMD specifically 1

While topical analgesics like lidocaine and benzocaine are available over-the-counter 6, 7, their use for HFMD is not supported by current evidence and guidelines. The focus should remain on supportive care, hydration, and systemic pain management with acetaminophen or ibuprofen.