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, focusing on pain relief and hydration, as no antiviral therapy is available or recommended. 1, 2

Symptomatic Management

Pain and Fever Control

• Use acetaminophen or NSAIDs (such as ibuprofen) for pain relief and fever reduction 1, 2
• Limit analgesic use to the shortest duration necessary to control symptoms 1
• Oral lidocaine is specifically not recommended for pain management 2

Oral Lesion Management

The mouth sores are often the most painful aspect of HFMD and require targeted care:

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
• Clean the mouth daily with warm saline mouthwashes 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 Manifestations (Hand and Foot Lesions)

• Apply intensive moisturizing care with urea-containing creams/ointments to hands and feet 1
• Avoid friction and heat exposure to affected areas 1
• For itchiness, zinc oxide can be applied as a protective barrier after gentle cleansing 1
• Apply zinc oxide in a thin layer and repeat as needed when itchiness returns 1
• Avoid applying zinc oxide to open or weeping lesions 1

Management of Open Sores on Feet

When vesicles have ruptured:

• 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

Expected Course and Follow-Up

• Lesions typically resolve in 7-10 days without sequelae 2, 3
• Fever and mouth sores usually last less than 1 week 4
• Reassess after 2 weeks if lesions are not improving with standard care 1

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 unnecessary, as by the time HFMD is diagnosed, the child has likely been shedding virus for weeks 1.

Prevention Measures

• Handwashing 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
• Children should avoid close contact with others until fever resolves and mouth sores heal 1

Special Considerations and Red Flags

Severe Disease Warning Signs

While most cases are benign, watch for complications, particularly with enterovirus 71:

• Neurological complications (encephalitis/meningitis, acute flaccid paralysis, acute flaccid myelitis) 1, 5
• Cardiopulmonary complications (myocardial impairment, neurogenic pulmonary edema) 5, 3
• Sudden onset of high fever with severe respiratory symptoms 5

High-Risk Populations

• Immunocompromised patients may experience more severe disease and require close monitoring 1
• Enterovirus 71 is associated with more severe outbreaks, especially in Asia 1

Common Pitfalls to Avoid

• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions 1
• Do not use chemical agents or plasters to remove corns or calluses 1
• Do not prescribe oral lidocaine for pain management 2
• Do not exclude children from daycare based solely on the presence of healing skin lesions 1