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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness requiring only supportive care with oral analgesics and intensive skin moisturization, as there are no approved antiviral therapies. 1

Symptomatic Management

Pain and Fever Control

• Use acetaminophen or NSAIDs for pain relief and fever reduction, administered for a limited duration as needed 1
• These medications address the common constitutional symptoms including fever that typically accompany HFMD 1

Oral Lesion Management

The oral ulcers are often the most painful aspect of HFMD and require targeted intervention:

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort 1
• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
• Use chlorhexidine oral rinse twice daily as an antiseptic measure 1
• For severe oral involvement (>grade 2), consider betamethasone sodium phosphate mouthwash four times daily and delay normal activities until symptoms resolve 1
• Use mild toothpaste and practice gentle oral hygiene 1

Skin Manifestations (Hand and Foot Lesions)

• Apply intensive moisturizing creams containing urea to hands and feet to manage skin lesions 1
• Avoid friction and heat exposure to affected areas 1
• Do not use chemical agents or plasters to remove associated corns or calluses 1

Managing Itchiness

• Apply zinc oxide 20% cream in a thin layer to itchy lesions after gentle cleansing of affected areas 1
• Reapply as needed when itchiness returns 1
• Avoid applying zinc oxide to open or weeping lesions 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
• Zinc oxide works as a protective barrier and has immune-modulating properties that may help with symptom management 1

Infection Control and Return to Activities

Preventing Transmission

• Hand hygiene with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers 1
• Clean toys and objects that may be placed in children's mouths 1
• Avoid sharing utensils, cups, or food 1

Return to Daycare/School Criteria

• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present 1
• Exclusion based solely on healing skin lesions is unnecessary 1
• By the time HFMD is diagnosed, the child has likely been shedding virus for weeks, posing limited additional risk 1

Special Considerations

Monitoring for Complications

While most cases resolve in 7-10 days without sequelae, be aware of severe complications particularly with enterovirus A71 (EV-A71): 2, 3

• Neurological complications: encephalitis/meningitis, acute flaccid paralysis, acute flaccid myelitis 1
• Cardiopulmonary complications: circulatory failure secondary to myocardial impairment, neurogenic pulmonary edema secondary to brainstem damage 2
• Immunocompromised patients may experience more severe disease and require closer monitoring 1

Secondary Bacterial Infections

• Treat any secondary bacterial infections that develop in skin lesions 1

Delayed Manifestations

• Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset 4

Common Pitfalls to Avoid

• Do not prescribe antiviral medications - there are no approved antiviral agents for HFMD treatment 2
• Do not exclude children from daycare based solely on persistent skin lesions after fever and oral lesions have resolved 1
• Do not use alcohol-based hand sanitizers as the primary prevention method - soap and water handwashing is more effective 1
• Do not confuse HFMD with other vesicular diseases including herpes simplex, herpangina, recurrent aphthae, or erythema multiforme 5