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

Treatment of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease requires only supportive care with oral analgesics for pain and fever control, as there are no approved antiviral treatments and the disease is self-limited, resolving in 7-10 days without sequelae. 1, 2

Primary Treatment Approach

Pain and Fever Management

• Use acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1, 3
• These are the cornerstone of symptomatic management and should be offered to all symptomatic patients 1

Oral Lesion Management

The painful oral ulcerations are often the most distressing symptom and require specific attention:

• 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 practices 1

Skin Lesion Management (Hands and Feet)

• Apply intensive moisturizing creams to hands and feet, 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 in a thin layer after gentle cleansing 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
• 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

Hydration Support

Maintaining adequate hydration is critical, especially when oral lesions make eating and drinking painful 3. Focus treatment on ensuring the child can maintain fluid intake 2.

When to Consider Advanced Treatment

Severe/Complicated Disease

• Intravenous immunoglobulin should be considered for severe or complicated HFMD and has been recommended by several national and international guideline committees 2
• This applies particularly to cases with neurological complications (encephalitis, meningitis, acute flaccid paralysis) or cardiopulmonary involvement 2, 4

Disease Caused by Enterovirus 71

EV-A71 causes more severe disease with higher complication rates compared to coxsackievirus A16 2, 4. Immunocompromised patients may experience more severe disease and should be monitored closely 1.

What NOT to Do

• Do not use oral lidocaine 3
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions 1
• Avoid applying zinc oxide to open or weeping lesions 1
• There are no specific antiviral agents approved for treatment 2, 3

Important Diagnostic Consideration

It is crucial to distinguish HFMD from herpes simplex virus, as HSV has available antiviral treatment options whereas HFMD does not 1. This distinction changes management entirely.

Prevention and Return to Activities

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

Return to Daycare/School

• 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
• By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others 1

Contact Precautions

• Avoid sharing utensils, cups, or food 1
• Children should avoid close contact with others until fever resolves and mouth sores heal 1

Common Pitfalls

The disease is transmitted by fecal-oral, oral-oral, and respiratory droplet contact 3, so transmission can occur even after clinical symptoms improve. The virus can be shed in stool for weeks after recovery 2. However, practical exclusion policies should focus on fever resolution and healed mouth sores rather than complete viral clearance 1.