What are the treatment options for an adult presenting with symptoms of hand, foot, and mouth disease?

Treatment of Hand, Foot, and Mouth Disease in Adults

Adults with hand, foot, and mouth disease should receive supportive care focused on symptom relief with oral analgesics (acetaminophen or NSAIDs), intensive oral hygiene with topical agents, and protective skin care—the disease is self-limited and typically resolves within one week without specific antiviral therapy. 1, 2

Symptom Management Approach

Pain and Fever Control

• Use oral analgesics such as acetaminophen or NSAIDs for limited duration to relieve pain and reduce fever 1
• Symptoms typically last less than 1 week in most cases 2

Oral Lesion Management

The mouth lesions often cause the most discomfort and require aggressive local care:

• 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
• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
• Apply chlorhexidine oral rinse twice daily as an antiseptic measure 1
• For severe oral involvement, use betamethasone sodium phosphate mouthwash four times daily 1
• Practice mild toothpaste and gentle oral hygiene 1

Skin Manifestations (Hand and Foot Lesions)

For intact vesicles and rash:

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products 1
• Avoid friction and heat exposure to affected areas 1
• Zinc oxide can be applied as a protective barrier to soothe inflamed areas and reduce itchiness 1
• Apply zinc oxide in a thin layer after gentle cleansing; reapply as needed 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to enhance effectiveness 1

For open sores on feet:

• Wash feet daily with careful drying, particularly between the toes 1
• Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores 1
• Monitor for signs of secondary bacterial infection including increased redness, warmth, purulent drainage, or worsening pain 1
• Treat any secondary bacterial infections that develop 1

When to Escalate Care

Red flags requiring immediate evaluation:

• Impaired consciousness, ptosis, or limb weakness suggesting neurological complications 3
• Severe cases, particularly with enterovirus 71, can cause encephalitis/meningitis, acute flaccid myelitis, or acute flaccid paralysis 1, 3
• Immunocompromised patients may experience more severe disease and require close monitoring 1

For suspected neurological involvement:

• Obtain cerebrospinal fluid analysis and brain/spinal cord MRI 3
• Consider IVIG therapy—a single dose has shown benefit in reducing fever, skin lesions, and recovery time in severe cases with CNS involvement 3

Important Caveats

• Atypical presentations are increasingly common in adults, particularly with coxsackievirus A6, which causes more severe and widespread disease beyond the classic hand-foot-mouth distribution 4, 5
• Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset 4
• Avoid applying zinc oxide to open or weeping lesions 1
• Do not use chemical agents or plasters to remove corns or calluses 1
• Do not routinely use topical antiseptic or antimicrobial dressings for HFMD foot lesions 1

Infection Control and Return to Activities

• Avoid close contact with others until fever resolves and mouth sores heal 1
• Practice thorough handwashing with soap and water (more effective than alcohol-based sanitizers) 1
• Avoid sharing utensils, cups, or food 1
• By the time HFMD is diagnosed, viral shedding has likely occurred for weeks, so exclusion based solely on healing skin lesions is unnecessary 1

Follow-Up

• Reassess after 2 weeks if lesions are not improving with standard care 1
• Monitor for delayed nail changes in the weeks following acute illness 4

Note on acyclovir: While one small study suggested benefit 6, this is not standard practice as the causative enteroviruses lack the thymidine kinase enzyme that acyclovir targets, and no guideline-level evidence supports its routine use.