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 symptomatic management of oral and skin lesions. 1
Supportive Care (Primary Treatment)
Pain and Fever Management:
- Use acetaminophen or NSAIDs for pain relief and fever reduction 1
- These should be used for a limited duration as needed 1
- Treatment is fundamentally palliative to reduce pain and irritation 2
Oral Lesion Management
Basic Oral Care:
- Use mild toothpaste and gentle oral hygiene practices 1
- Apply white soft paraffin ointment to lips every 2 hours to prevent drying and cracking 1
- Clean the mouth daily with warm saline mouthwashes 1
For More Severe Oral Involvement:
- 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
- Consider betamethasone sodium phosphate mouthwash four times daily for severe oral involvement 1
- Delay normal activities until symptoms resolve for severe oral ulcers (grade >2) 1
Skin Manifestation Management
Hand and Foot Lesions:
- Apply intensive moisturizing care with urea-containing creams/ointments to hands and feet 1
- Avoid friction and heat exposure to affected areas 1
- Do NOT use chemical agents or plasters to remove corns or calluses 1
For Itchiness:
- Apply zinc oxide 20% 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 nighttime relief, apply zinc oxide in a thin layer followed by loose cotton gloves to enhance effectiveness 1
Infection Control and Return to Activities
Hygiene Measures:
- Hand hygiene with thorough handwashing using soap and water is the most important preventive measure (more effective than alcohol-based sanitizers) 1
- Avoid sharing utensils, cups, or food 1
- Clean toys and objects that may be placed in children's mouths 1
Return to Daycare/School:
- Children can return 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 not necessary 1
Special Considerations
Secondary Infections:
- Treat any secondary bacterial infections that develop 1
Immunocompromised Patients:
- Monitor closely as they may experience more severe disease 1
Expected Course:
- Symptoms typically last less than 1 week 3
- Lesions usually regress in 2-3 weeks 2
- Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset 4
- The disease is self-limiting 5
Important Caveat
The evidence provided includes guidelines for chemotherapy-induced hand-foot syndrome (HFS/HFSR), which is a completely different condition from viral HFMD despite similar naming 6. These chemotherapy-related guidelines should not be applied to viral HFMD management.