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

Treatment of Hand, Foot, and Mouth Disease in Adults

Hand, foot, and mouth disease in adults is treated with supportive care focused on symptom relief, including oral analgesics for pain and fever, intensive oral hygiene measures for mouth lesions, and protective skin care for hand and foot lesions. 1

Pharmacologic Management

Pain and Fever Control

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever. 1 These are the first-line oral analgesics recommended for symptom management.
• Dosing should target adequate pain control while symptoms persist, typically 7-14 days until complete resolution. 2, 3

Oral Lesion Management

The mouth sores often cause the most significant discomfort and require aggressive local therapy:

• 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 or use an oral sponge for comfort. 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 techniques. 1

Non-Pharmacologic Management

Hand and Foot Lesion Care

• Apply intensive moisturizing creams to hands and feet, particularly urea-containing products. 1
• Avoid friction and heat exposure to affected areas. 1
• For itchy lesions, apply zinc oxide in a thin layer after gentle cleansing, which acts as a protective barrier and has immune-modulating properties. 1
• For nighttime relief, apply zinc oxide followed by loose cotton gloves to enhance effectiveness. 1
• Avoid applying zinc oxide to open or weeping lesions. 1

Foot Care for Open Sores

• 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
• Do not use chemical agents or plasters to remove corns or calluses. 1
• Do not routinely use topical antiseptic or antimicrobial dressings for HFMD foot lesions. 1

Monitoring and Follow-Up

Watch for Complications

• Monitor for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain. 1
• Be vigilant for neurological complications in adults, including encephalitis, meningitis, acute flaccid myelitis, or acute flaccid paralysis, particularly with enterovirus 71. 1, 4
• Look for impaired consciousness, ptosis, limb weakness, or decreased muscle power as warning signs. 4

Timeline Expectations

• Symptoms typically resolve within 7-14 days with supportive care alone. 2, 3, 5
• Reassess after 2 weeks if lesions are not improving with standard care. 1

Special Considerations

Severe Disease

• For confirmed enterovirus 71-induced encephalomyelitis, prompt IVIG therapy (single dose) can reduce fever, skin lesions, and recovery time. 4 This requires cerebrospinal fluid RT-PCR confirmation and MRI evidence of CNS involvement. 4

Infection Control

• Avoid close contact with others until fever resolves and mouth sores heal, even if skin rash persists. 1
• Practice thorough handwashing with soap and water, which is more effective than alcohol-based sanitizers. 1
• Avoid sharing utensils, cups, or food. 1

Common Pitfalls

• Do not dismiss faint or difficult-to-visualize lesions—comprehensive examination of hands, feet, mouth, and buttocks is essential. 2
• Do not assume adults are immune—HFMD occurs at all ages, often transmitted from infected children. 2, 3, 5
• Do not overlook contact history with HFMD patients, which aids diagnosis even when lesions are subtle. 4, 5