Steroid Treatment for Coxsackie (Hand, Foot, and Mouth Disease) Sores
Steroids are NOT recommended for the treatment of Coxsackie virus-related hand, foot, and mouth disease (HFMD) sores, as there is no evidence supporting their efficacy and they may potentially worsen outcomes.
Evidence Against Steroid Use in HFMD
The available evidence does not support the use of corticosteroids for HFMD management:
A large retrospective study of 3,778 hospitalized HFMD cases in China found no significant advantage of using steroids, either alone or in combination with IVIG, in the management of mild HFMD cases 1
The same study demonstrated that recovery rates were not improved with steroid use, and longer hospital stays were observed when steroids were used in severe cases 1
This contradicts Chinese national guidelines that recommend steroids, highlighting a disconnect between local practice patterns and actual clinical outcomes 1
Recommended Management Approach
For Mild to Moderate HFMD Sores:
Supportive care remains the cornerstone of treatment:
- Symptomatic relief with analgesics for pain control 1
- Adequate hydration and nutrition support 1
- Monitoring for complications 1
Topical Considerations:
While the evidence provided focuses on inflammatory dermatologic conditions rather than viral exanthems, topical steroids are not indicated for viral lesions like HFMD as they:
- Do not address the underlying viral pathology
- May theoretically impair local immune response to viral infection
- Are reserved for inflammatory (non-infectious) skin conditions 2, 3
Important Clinical Pitfalls
Avoid the temptation to prescribe steroids for symptomatic relief - despite their anti-inflammatory properties, the retrospective data shows no benefit and potential harm in terms of prolonged hospitalization 1
The WHO and US-CDC guidelines do not recommend steroids for HFMD, which should guide clinical practice over regional variations in treatment approaches 1
Alternative Considerations
- One small study suggested potential benefit of acyclovir in HFMD, though the mechanism remains unclear given that Coxsackievirus lacks the target enzyme for acyclovir 4
- Traditional Chinese herb Lan-Qin showed higher recovery rates in mild cases in one retrospective study, though this requires validation in randomized trials 1