What is the treatment for hand, foot, and mouth disease (HFMD) in adults?

Treatment of Hand, Foot, and Mouth Disease in Adults

Treatment of HFMD in adults is entirely supportive, focusing on symptom relief with oral analgesics, intensive skin care, and management of oral lesions—no antiviral therapy is recommended for uncomplicated cases. 1

Symptomatic Pain and Fever Management

• Use acetaminophen or NSAIDs for pain relief and fever reduction, limiting duration to avoid prolonged use 1
• These medications address both constitutional symptoms (fever, malaise) and discomfort from skin and oral lesions 1

Oral Lesion Management

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 2
• Use mild toothpaste and practice gentle oral hygiene to avoid irritating existing lesions 1
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort 2
• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 2
• Use chlorhexidine oral rinse twice daily as an antiseptic measure 2
• Consider betamethasone sodium phosphate mouthwash four times daily for more severe oral involvement 2

Skin Manifestation Management (Hands and Feet)

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products, to maintain skin integrity 1
• Avoid friction and heat exposure to affected areas to prevent worsening of lesions 1
• Do not use chemical agents or plasters to remove corns or calluses that may develop 1

For Itchiness Relief

• Apply zinc oxide 20% cream as a protective barrier after gentle cleansing of affected areas 1
• Zinc oxide can be reapplied as needed when itchiness returns 1
• Avoid applying to open or weeping lesions 1
• For enhanced nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1

Monitoring for Complications

• Watch for neurological symptoms including severe headache, altered mental status, or weakness, as enterovirus 71 can cause encephalitis/meningitis, acute flaccid paralysis, or acute flaccid myelitis in severe cases 1
• Monitor for respiratory symptoms such as difficulty breathing or pulmonary edema, particularly in severe disease 3
• Treat any secondary bacterial infections that develop with appropriate antibiotics 1

Activity Restrictions and Contagion

• Avoid close contact with others until fever resolves and mouth sores heal, even if skin rash persists 1
• The skin rash alone is not a reason for continued isolation, as viral shedding occurs primarily through respiratory secretions and stool 1
• Avoid sharing utensils, cups, or food to prevent transmission 1

Expected Course

• Complete resolution typically occurs within 1-2 weeks 4, 5
• The disease is self-limiting in immunocompetent adults 3, 6
• Onychomadesis (nail loss) may occur up to 2 months after initial symptoms, particularly with coxsackievirus A6 infections, but requires no specific treatment 3

When Antiviral Therapy May Be Considered

• Ribavirin may be used only in severe cases requiring mechanical ventilation or with significant neurological/cardiac complications 3
• This is not indicated for typical adult HFMD cases 3