Is toradol (ketorolac) and dexamethasone effective for treating Hand, Foot, and Mouth Disease (HFMD) in adults?

Toradol and Dexamethasone for Hand, Foot, and Mouth Disease in Adults

Toradol (ketorolac) and dexamethasone are not recommended as standard treatment for Hand, Foot, and Mouth Disease (HFMD) in adults, as supportive care with acetaminophen or NSAIDs for symptom management is the appropriate first-line approach. 1

Understanding Hand, Foot, and Mouth Disease in Adults

Hand, Foot, and Mouth Disease is a viral illness primarily caused by enteroviruses, with the following characteristics:

• Typically presents with fever as the first symptom, followed by development of vesicular lesions on hands, feet, and in the mouth 1, 2
• In adults, symptoms may include fever, malaise, sore throat, and painful oral lesions that can interfere with eating and drinking 1
• The condition is generally self-limiting, with symptoms resolving within 7-10 days without specific antiviral treatment 1

Recommended Treatment Approach

First-Line Treatment (Supportive Care)

• Oral analgesics such as acetaminophen or standard NSAIDs are recommended for pain relief and fever reduction 1
• Intensive skin care with moisturizing creams, particularly urea-containing products, for hand and foot lesions 1
• Mild toothpaste and gentle oral hygiene for management of oral lesions 1
• Adequate hydration and soft, non-irritating foods to minimize discomfort from oral lesions 1

Management of Specific Symptoms

For oral lesions/stomatitis:

• Early intervention is recommended to prevent worsening of symptoms 1
• Topical oral anesthetics may provide temporary relief 1

For skin manifestations:

• Avoid friction and heat exposure to affected areas 1
• Zinc oxide may help with itchiness by creating a protective barrier on the skin 1

Evidence Regarding Ketorolac and Dexamethasone

While there is no specific evidence supporting the use of ketorolac and dexamethasone for HFMD, studies in other conditions provide context:

• Ketorolac has demonstrated analgesic efficacy for acute pain but has limitations including delayed onset (30-60 minutes) and variable response rates 3
• Dexamethasone has shown effectiveness in preventing recurrence of pain in migraine headaches with fewer side effects compared to other medications 4
• When compared directly in inflammatory conditions, dexamethasone has demonstrated advantages over ketorolac in some parameters, such as reducing limitation of mouth opening after dental procedures 5

Why These Medications Are Not Recommended for HFMD

• HFMD is a viral infection that resolves spontaneously, and treatment should focus on symptom management rather than anti-inflammatory interventions 1
• No clinical guidelines specifically recommend ketorolac or dexamethasone for HFMD management 1, 2
• The potential risks of these medications (gastric irritation, fluid retention, blood glucose elevation with dexamethasone; renal effects with ketorolac) outweigh any theoretical benefits for a self-limiting condition 1

Special Considerations

• If severe symptoms persist despite supportive care, evaluation for complications or secondary bacterial infections is warranted 1
• Immunocompromised patients may experience more severe disease and should be monitored closely 1
• Adults can return to work once fever has resolved and mouth sores have healed, even if skin rash is still present 1

Conclusion

For adults with HFMD who are not improving with standard supportive care, focus on:

1. Ensuring adequate pain control with appropriate doses of standard oral analgesics
2. Maintaining hydration and nutrition despite oral discomfort
3. Evaluating for potential complications or secondary infections
4. Considering consultation with infectious disease specialists for unusually severe or persistent cases

The use of ketorolac and dexamethasone should be reserved for other clinical scenarios where their benefits are supported by evidence.