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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is primarily managed with supportive care focused on symptom relief, as the disease is self-limited and resolves in 7-10 days without sequelae in most cases. 1

Symptomatic Pain and Fever Management

• Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 2
• These analgesics address both the constitutional symptoms (fever) and discomfort from oral and skin lesions. 2

Oral Lesion Management

The oral lesions are often the most painful aspect of HFMD and require targeted intervention:

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 2
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort. 2
• Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain. 2
• Use chlorhexidine oral rinse twice daily as an antiseptic measure. 2
• For more severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily. 2
• Use mild toothpaste and gentle oral hygiene practices. 2

Skin Manifestation Management

For Hand and Foot Lesions

• Apply intensive skin care with moisturizing creams, particularly urea-containing products, to hands and feet. 2
• Avoid friction and heat exposure to affected areas. 2
• For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing of affected areas, repeated as needed. 2
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier. 2
• Avoid applying zinc oxide to open or weeping lesions. 2

For Open Sores on Feet

• Wash feet daily with careful drying, particularly between the toes. 2
• Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions. 2
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores. 2
• Monitor for signs of secondary bacterial infection including increased redness, warmth, purulent drainage, or worsening pain. 2
• Treat any secondary bacterial infections that develop. 2

Isolation and Return to Activities

• Children should avoid close contact with others until fever resolves and mouth sores heal. 2
• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present—exclusion based solely on healing skin lesions is unnecessary. 2
• By the time HFMD is diagnosed, the child has likely been shedding virus for weeks, posing limited additional risk. 2

Prevention Measures

• Hand hygiene with thorough handwashing using soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers. 2
• Clean toys and objects that may be placed in children's mouths. 2
• Avoid sharing utensils, cups, or food. 2

Severe Disease Management

For severe cases with neurological or cardiopulmonary complications (primarily EV-A71 infections), intravenous immunoglobulin should be considered and has been recommended by several national and international guideline committees. 1

Warning Signs Requiring Escalation of Care

Clinicians should recognize these indicators of possible deterioration, particularly in EV-A71 cases in children under 3 years with disease duration less than 3 days: 3

• Persistent hyperthermia 3
• Involvement of nervous system 3
• Worsening respiratory rate and rhythm 3
• Circulatory dysfunction 3
• Elevated peripheral WBC count 3
• Elevated blood glucose 3
• Elevated blood lactic acid 3

Special Considerations

• Immunocompromised patients may experience more severe disease and should be monitored closely. 2
• Most mild cases can be treated as outpatients with isolation to avoid cross-infection. 3
• Intense treatment modalities including mechanical ventilation should be given for severe cases. 4, 3

Common Pitfalls to Avoid

• Do not use chemical agents or plasters to remove corns or calluses associated with HFMD lesions. 2
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions, as these are not recommended for wound healing. 2
• Do not delay intervention for severe oral ulcers (>grade 2). 2
• Be aware that nail changes (onychomadesis) may occur weeks after initial symptoms, particularly with coxsackievirus A6 infections. 4, 5