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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease is a self-limited viral illness requiring only supportive care with oral analgesics (acetaminophen or NSAIDs) for pain and fever relief, combined with intensive skin care and oral hygiene measures. 1

Symptomatic Management

Pain and Fever Control

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
• Oral lidocaine is not recommended for symptom management 2
• No antiviral treatment is currently available or approved for HFMD 2, 3

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 or use an oral sponge for comfort 1
• 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
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1
• Use mild toothpaste and gentle oral hygiene practices 1

Skin and Foot Lesion Care

• Apply intensive skin care with moisturizing creams, particularly urea-containing products, to hands and feet 1
• Avoid friction and heat exposure to affected areas 1
• For itchiness, apply zinc oxide in a thin layer after gentle cleansing of affected areas; can be repeated as needed 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
• Avoid applying zinc oxide to open or weeping lesions 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 induces skin maceration and worsens open sores 1
• Avoid using chemical agents or plasters to remove corns or calluses 1
• Do not use topical antiseptic or antimicrobial dressings routinely 1

Monitoring and Follow-Up

Signs Requiring Closer Monitoring

• Monitor for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
• Immunocompromised patients may experience more severe disease and require close monitoring 1
• Watch for neurological complications (encephalitis/meningitis, acute flaccid myelitis, acute flaccid paralysis), particularly with Enterovirus 71 infections 1
• Reassess after 2 weeks if lesions are not improving with standard care 1

Expected Course

• Lesions usually resolve in 7-10 days without sequelae 2, 3
• Most cases are benign and self-limited 3
• Nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset 4

Prevention and Infection Control

Hand Hygiene

• Handwashing with soap and water is more effective than alcohol-based hand sanitizers and is the most important preventive measure 1
• Disinfect toys and objects that may be placed in children's mouths 1

Isolation and Return to Activities

• Children can return to daycare 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
• Avoid close contact with others until fever resolves and mouth sores heal 1
• Avoid sharing utensils, cups, or food 1

Healthcare Settings

• Follow standard precautions and good hand hygiene practices 1

Common Pitfalls to Avoid

• Do not prescribe oral lidocaine for oral lesions 2
• Do not seek antiviral therapy, as none is approved or available 2, 3
• Do not exclude children from daycare based solely on persistent skin lesions after fever and oral lesions have resolved 1
• Do not use topical antiseptics or antimicrobial dressings routinely on foot lesions 1
• Do not soak feet in footbaths when open sores are present 1