What topical ointments can be prescribed for hand, foot, and mouth disease?

Topical Ointments for Hand, Foot, and Mouth Disease

For hand, foot, and mouth disease, white soft paraffin ointment applied to the lips every 2 hours and to urogenital skin/mucosae every 4 hours is the primary topical treatment recommended, along with zinc oxide for itchy skin lesions and intensive moisturizing with urea-containing creams for hand and foot care. 1

Specific Topical Treatments by Location

Oral/Lip Lesions

• Apply white soft paraffin ointment to the lips every 2 hours throughout the acute illness to prevent drying and cracking 2, 1
• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 2, 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 2, 1
• Apply chlorhexidine oral rinse twice daily as an antiseptic measure 2, 1

Hand and Foot Lesions

• Apply intensive moisturizing creams, particularly urea cream/ointment, to hands and feet to maintain skin barrier function 1
• Zinc oxide 20% can be applied to itchy skin lesions as a protective barrier that soothes inflamed areas 1
  • Apply in a thin layer after gentle cleansing of affected areas 1
  • Can be repeated as needed when itchiness returns 1
  • For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
  • Avoid applying to open or weeping lesions 1

Urogenital Involvement (if present)

• Apply white soft paraffin ointment to urogenital skin and mucosae every 4 hours during acute illness 2
• Use a potent topical corticosteroid ointment once daily to involved but non-eroded surfaces 2

Important Caveats

Do not use chemical agents or plasters to remove corns or calluses on affected areas, as this can worsen tissue damage 1

Do not routinely use topical antiseptic or antimicrobial dressings for HFMD foot lesions, as these are not recommended for wound healing 1

Avoid friction and heat exposure to affected areas while using these topical treatments 1

Supportive Measures Beyond Topicals

While topical treatments address local symptoms, systemic pain relief with acetaminophen or NSAIDs for limited duration is recommended for fever and pain 1, 3. The disease is typically self-limiting and resolves in 7-10 days without sequelae 3, 4.