What medication is recommended for a child with hand, foot, and mouth disease (HFMD) experiencing itching?

Management of Itching in Hand, Foot, and Mouth Disease

Oral antihistamines are recommended as the first-line treatment for managing itching in children with hand, foot, and mouth disease (HFMD). 1

First-Line Treatment Options

Oral Antihistamines

• Non-sedating (daytime use):

  • Loratadine 10 mg daily (adjust dose based on child's weight/age) 1
  • Cetirizine (age-appropriate dosing)

• Sedating (nighttime use):

  • Diphenhydramine 25-50 mg daily (adjust for child's weight/age) 1
  • Hydroxyzine 25-50 mg daily (adjust for child's weight/age) 1
  • Chlorphenamine (considered safest in young children) 1

Supportive Measures

Topical Treatments

• Cool compresses to affected areas 1
• Oatmeal baths for symptomatic relief 1
• Emollients applied liberally and frequently (3-8 times daily) to maintain skin hydration 2

Pain Management

• Acetaminophen or ibuprofen for pain relief and fever control 3
• Avoid oral lidocaine as it is not recommended for HFMD 3

Important Considerations

Medication Selection

• For children with renal impairment, avoid acrivastine and adjust doses of cetirizine and levocetirizine 1
• For children with hepatic impairment, avoid mizolastine and alimemazine 1
• Always check age restrictions and adjust dosing based on the child's weight 1

Cautions

• Avoid topical antihistamines as they may increase the risk of contact dermatitis 1
• Avoid long-term oral corticosteroids for managing itching in HFMD 1
• Avoid scratching to prevent secondary bacterial infections; keep nails short 2

When to Escalate Care

• If severe symptoms persist despite antihistamine therapy
• If signs of neurological complications develop (rare but possible with HFMD) 4
• If dehydration occurs due to painful oral lesions limiting fluid intake 3

Disease Course

• HFMD is typically self-limiting with lesions resolving in 7-10 days 3
• Itching is a common symptom that can be effectively managed with the above measures
• The disease is highly contagious; emphasize handwashing and disinfection of contaminated surfaces to prevent spread 3

Remember that HFMD is caused by enteroviruses (commonly coxsackieviruses A16, A6, A10, and enterovirus 71) and there is currently no specific antiviral treatment available 5. Management focuses on symptom relief while the infection runs its course.