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, along with measures to maintain hydration and prevent transmission through handwashing. 1, 2
Symptom 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 pain management 2
- No antiviral treatment is available or indicated 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 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
Hand and Foot Lesion Care
- Apply intensive skin care with moisturizing creams, particularly urea-containing products 1
- Avoid friction and heat exposure to affected areas 1
- Do not use chemical agents or plasters to remove corns or calluses 1
- For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing of affected areas 1
- Apply zinc oxide in a thin layer; for nighttime relief, consider applying followed by loose cotton gloves 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 can induce skin maceration and worsen 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
- Reassess after 2 weeks if lesions are not improving with standard care 1
Hydration Support
- Direct treatment toward maintaining adequate hydration, as oral ulcerations can make eating and drinking painful 2
- This is particularly important in young children who may refuse oral intake 3
Disease Course and Monitoring
- Lesions usually resolve in 7 to 10 days without intervention 2, 3
- Monitor closely for neurological complications (encephalitis/meningitis, acute flaccid myelitis, acute flaccid paralysis), particularly with Enterovirus 71 infections 1
- Watch for cardiopulmonary complications in rare severe cases 2, 4
- Immunocompromised patients may experience more severe disease and require closer monitoring 1
Special Considerations for Severe Disease
- Intravenous immunoglobulin should be considered for severe/complicated hand, foot, and mouth disease 3
- Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death in severe cases 3
Prevention and Transmission Control
- Handwashing with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers 1
- Disinfect toys and objects that may be placed in children's mouths 1
- Avoid sharing utensils, cups, or food 1
- 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, as by the time HFMD is diagnosed, the child has likely had the infection for weeks 1
- Standard precautions and good hand hygiene practices should be followed in healthcare settings 1