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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires supportive care only, with oral analgesics (acetaminophen or NSAIDs) for pain and fever relief, along with intensive skin care and oral hygiene measures. 1

Symptomatic Management

Pain and Fever Control

• Use acetaminophen or ibuprofen for pain relief and fever reduction 1, 2
• Administer these medications for a limited duration as needed 1
• Avoid oral lidocaine, as it is not recommended 2

Oral Lesion Management

• 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 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, consider betamethasone sodium phosphate mouthwash four times daily 1
• Use mild toothpaste and gentle oral hygiene practices 1

Skin Care for Hand and Foot Lesions

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products 1
• Use zinc oxide as a protective barrier to soothe inflamed areas and reduce itchiness 1
• Apply zinc oxide in a thin layer after gentle cleansing, repeating as needed 1
• Avoid applying zinc oxide to open or weeping lesions 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to enhance effectiveness 1

Management of 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 can induce skin maceration and worsen open sores 1
• Avoid chemical agents or plasters to remove corns or calluses 1

Monitoring and Complications

When to Monitor Closely

• Watch for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
• Monitor immunocompromised patients closely, as they may experience more severe disease 1
• Be alert for neurological complications (encephalitis, meningitis, acute flaccid myelitis, acute flaccid paralysis), particularly with Enterovirus 71 1
• Reassess after 2 weeks if lesions are not improving with standard care 1

Disease Course

• Lesions typically resolve in 7-10 days without sequelae 2, 3
• The disease is usually self-limited and benign 3, 4

Prevention and Return to Activities

Infection Control

• 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
• Disinfect potentially contaminated surfaces and fomites 2

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
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others 1

Important Caveats

No antiviral treatment is currently available or approved for hand, foot, and mouth disease 2, 3. While intravenous immunoglobulin has been recommended by some guideline committees for severe/complicated cases 3, the vast majority of cases require only supportive care as outlined above. Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions, as these are not recommended for wound healing 1.